Provider First Line Business Practice Location Address:
431 W 13TH AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-5782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-743-9003
Provider Business Practice Location Address Fax Number:
760-743-9007
Provider Enumeration Date:
12/02/2014