Provider First Line Business Practice Location Address:
215 S HICKORY ST
Provider Second Line Business Practice Location Address:
STE 126
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-3439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-745-7313
Provider Business Practice Location Address Fax Number:
760-745-6360
Provider Enumeration Date:
06/22/2005