Provider First Line Business Practice Location Address:
127 E 3RD AVE STE 100
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:
92025-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-740-5979
Provider Business Practice Location Address Fax Number:
760-740-0612
Provider Enumeration Date:
10/05/2006