Provider First Line Business Practice Location Address:
225 E 2ND AVE
Provider Second Line Business Practice Location Address:
STE. 310
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-738-9985
Provider Business Practice Location Address Fax Number:
760-738-0590
Provider Enumeration Date:
11/01/2006