Provider First Line Business Practice Location Address:
210 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:
92025-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-747-4411
Provider Business Practice Location Address Fax Number:
760-747-6392
Provider Enumeration Date:
11/11/2005