Provider First Line Business Practice Location Address:
1500 S EL CAMINO REAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-533-7776
Provider Business Practice Location Address Fax Number:
760-944-6784
Provider Enumeration Date:
09/11/2007