Provider First Line Business Practice Location Address:
421 E MISSION 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:
92025-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-747-0430
Provider Business Practice Location Address Fax Number:
760-747-0340
Provider Enumeration Date:
06/22/2005