Provider First Line Business Practice Location Address:
116 W PLAZA STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SOLANA BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92075-1124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-755-1591
Provider Business Practice Location Address Fax Number:
858-755-8396
Provider Enumeration Date:
05/21/2008