Provider First Line Business Practice Location Address:
215 S HICKORY ST
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-336-2810
Provider Business Practice Location Address Fax Number:
949-798-7990
Provider Enumeration Date:
06/28/2007