Provider First Line Business Practice Location Address:
2135 MONTIEL RD BLDG B
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:
92069-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-975-0170
Provider Business Practice Location Address Fax Number:
760-975-0177
Provider Enumeration Date:
04/23/2008