Provider First Line Business Practice Location Address:
1737 EDGEFIELD LANE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-519-2179
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2009