Provider First Line Business Practice Location Address:
641 E PENNSYLVANIA AVE STE 102
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:
92025-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-520-8200
Provider Business Practice Location Address Fax Number:
760-737-5490
Provider Enumeration Date:
07/26/2006