Provider First Line Business Practice Location Address:
119 N EL CAMINO REAL
Provider Second Line Business Practice Location Address:
#A
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-5397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-753-5544
Provider Business Practice Location Address Fax Number:
760-753-5877
Provider Enumeration Date:
09/26/2006