Provider First Line Business Practice Location Address:
543 ENCINITAS BLVD
Provider Second Line Business Practice Location Address:
STE. 113
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-3744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-944-7870
Provider Business Practice Location Address Fax Number:
760-944-4265
Provider Enumeration Date:
12/06/2007