Provider First Line Business Practice Location Address:
425 1/2 SANTA FE 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:
92024-5134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-633-1541
Provider Business Practice Location Address Fax Number:
760-633-1548
Provider Enumeration Date:
07/10/2006