Provider First Line Business Practice Location Address:
345 S COAST HIGHWAY 101 STE A
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:
92024-3552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-487-5212
Provider Business Practice Location Address Fax Number:
760-487-5213
Provider Enumeration Date:
11/13/2006