Provider First Line Business Practice Location Address:
100 N RANCHO SANTA FE RD
Provider Second Line Business Practice Location Address:
SUITE 126
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92069-1294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-598-0400
Provider Business Practice Location Address Fax Number:
760-290-7044
Provider Enumeration Date:
12/01/2005