Provider First Line Business Practice Location Address:
727 W SAN MARCOS BLVD
Provider Second Line Business Practice Location Address:
113
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92078-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-744-5959
Provider Business Practice Location Address Fax Number:
760-744-5960
Provider Enumeration Date:
08/29/2005