Provider First Line Business Practice Location Address:
115 NORTH EL CAMINO REAL SUITE A
Provider Second Line Business Practice Location Address:
115 NORTH EL CAMINO REAL SUITE A
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92058-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-330-5055
Provider Business Practice Location Address Fax Number:
760-542-2026
Provider Enumeration Date:
10/16/2006