Provider First Line Business Practice Location Address:
650 SAN DIEGUITO DR
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:
92024-4536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-230-2829
Provider Business Practice Location Address Fax Number:
209-524-4240
Provider Enumeration Date:
11/04/2005