Provider First Line Business Practice Location Address:
1228 N COAST HIGHWAY 101
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-1493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-538-8404
Provider Business Practice Location Address Fax Number:
858-538-0456
Provider Enumeration Date:
04/28/2008