Provider First Line Business Practice Location Address:
307 S IVY ST
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:
92025-4337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-746-1133
Provider Business Practice Location Address Fax Number:
760-746-9880
Provider Enumeration Date:
12/30/2006