Provider First Line Business Practice Location Address:
225 E 3RD 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:
92025-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-741-1176
Provider Business Practice Location Address Fax Number:
760-740-9124
Provider Enumeration Date:
06/26/2006