Provider First Line Business Practice Location Address:
740 NORDAHL RD.
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-432-9000
Provider Business Practice Location Address Fax Number:
760-741-0746
Provider Enumeration Date:
09/15/2008