Provider First Line Business Practice Location Address:
425 W 5TH AVE STE 101
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:
92025-4843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-258-4780
Provider Business Practice Location Address Fax Number:
760-280-8335
Provider Enumeration Date:
03/03/2026