Provider First Line Business Practice Location Address:
1114 NORTH COAST HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 1A
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:
760-943-7667
Provider Business Practice Location Address Fax Number:
760-943-7667
Provider Enumeration Date:
07/27/2009