Provider First Line Business Practice Location Address:
925 E PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
STE H
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-3432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-741-1005
Provider Business Practice Location Address Fax Number:
760-741-1032
Provider Enumeration Date:
11/27/2006