Provider First Line Business Practice Location Address:
251 E 4TH 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:
92025-4901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-745-5412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2006