Provider First Line Business Practice Location Address:
342 S KALMIA ST
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:
92025-4209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-747-2020
Provider Business Practice Location Address Fax Number:
760-747-0663
Provider Enumeration Date:
06/15/2011