Provider First Line Business Practice Location Address:
838 NORDAHL RD
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92069-3595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-743-1161
Provider Business Practice Location Address Fax Number:
760-743-3367
Provider Enumeration Date:
12/19/2006