Provider First Line Business Practice Location Address:
200 E WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-737-8642
Provider Business Practice Location Address Fax Number:
760-737-8918
Provider Enumeration Date:
05/19/2008