Provider First Line Business Practice Location Address:
838 NORDAHL RD STE 220
Provider Second Line Business Practice Location Address:
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:
760-738-9985
Provider Business Practice Location Address Fax Number:
800-838-2695
Provider Enumeration Date:
07/12/2006