Provider First Line Business Practice Location Address:
112 ENCINITAS BLVD
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:
92024-3642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-632-9674
Provider Business Practice Location Address Fax Number:
790-632-6948
Provider Enumeration Date:
12/10/2008