Provider First Line Business Practice Location Address:
2141 S EL CAMINO REAL STE A&B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-9003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-278-9030
Provider Business Practice Location Address Fax Number:
443-842-7264
Provider Enumeration Date:
01/27/2009