Provider First Line Business Practice Location Address:
1924 COMMERCIAL 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:
92029-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-835-9390
Provider Business Practice Location Address Fax Number:
310-835-3926
Provider Enumeration Date:
05/28/2008