Provider First Line Business Practice Location Address:
811 W SAN MARCOS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92078-1112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-744-8223
Provider Business Practice Location Address Fax Number:
760-471-0549
Provider Enumeration Date:
07/03/2006