Provider First Line Business Practice Location Address:
1001 S HALE AVE SPC 16
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:
92029-2175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-307-1412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2023