Provider First Line Business Practice Location Address:
127 E 3RD AVE
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:
92025-4254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-685-3403
Provider Business Practice Location Address Fax Number:
760-751-8650
Provider Enumeration Date:
10/02/2007