Provider First Line Business Practice Location Address:
457 N ELM ST
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:
92025-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-489-1969
Provider Business Practice Location Address Fax Number:
760-489-5226
Provider Enumeration Date:
07/05/2019