Provider First Line Business Practice Location Address:
403 W 9TH 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:
92025-5034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-839-0100
Provider Business Practice Location Address Fax Number:
760-839-0140
Provider Enumeration Date:
03/19/2014