Provider First Line Business Practice Location Address:
2402 OLD RANCH RD
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:
92027-6727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-855-5423
Provider Business Practice Location Address Fax Number:
877-359-0651
Provider Enumeration Date:
11/28/2006