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I always found the best combination was a photo resist method, with a small CNC machine for drilling and routing the PCB.

precision and accuracy is all about alignment, so i built alignment guides into all my printouts.

I uploaded some photos of a one + the alignment guides I used, i even did nickel plating and a silkscreen on this one...

heres a short video of the CNC drilling machine too, it was homemade

used to take maybe 1-2 hours start to finish to manufacture a full PCB