Provider First Line Business Practice Location Address:
2181 S EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-6220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-929-9010
Provider Business Practice Location Address Fax Number:
760-966-7446
Provider Enumeration Date:
10/19/2005