Provider First Line Business Practice Location Address:
342 S BROADWAY
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:
92025-4207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-747-4242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2015