Provider First Line Business Practice Location Address:
1635 LAKE SAN MARCOS DR STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92078-4698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-471-9444
Provider Business Practice Location Address Fax Number:
760-471-4886
Provider Enumeration Date:
12/05/2006