Provider First Line Business Practice Location Address:
1443 ENCINITAS BLVD
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:
92024-2931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-635-3478
Provider Business Practice Location Address Fax Number:
760-635-9384
Provider Enumeration Date:
10/01/2006