Provider First Line Business Practice Location Address:
2201 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:
92027-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-432-2448
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2010