Provider First Line Business Practice Location Address:
245 W EL NORTE PKWY
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92026-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-740-0409
Provider Business Practice Location Address Fax Number:
760-740-0412
Provider Enumeration Date:
03/09/2007