Provider First Line Business Practice Location Address:
355 E GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-480-6519
Provider Business Practice Location Address Fax Number:
760-480-1012
Provider Enumeration Date:
03/28/2006