Provider First Line Business Practice Location Address:
848 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-479-1450
Provider Business Practice Location Address Fax Number:
760-479-1496
Provider Enumeration Date:
06/22/2009