Provider First Line Business Practice Location Address:
2124 S EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-722-9393
Provider Business Practice Location Address Fax Number:
760-722-2836
Provider Enumeration Date:
08/11/2005