Provider First Line Business Practice Location Address:
111 W WASHINGTON 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:
92025-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-291-0299
Provider Business Practice Location Address Fax Number:
760-291-0212
Provider Enumeration Date:
09/30/2011