Provider First Line Business Practice Location Address:
255 N ELM ST
Provider Second Line Business Practice Location Address:
STE. 202
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-504-0223
Provider Business Practice Location Address Fax Number:
760-504-0224
Provider Enumeration Date:
08/19/2014