Provider First Line Business Practice Location Address:
2111 S EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-729-5433
Provider Business Practice Location Address Fax Number:
760-729-1764
Provider Enumeration Date:
11/17/2010