Provider First Line Business Practice Location Address:
328 ENCINITAS BLVD
Provider Second Line Business Practice Location Address:
SUITE#100
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-8704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-528-4600
Provider Business Practice Location Address Fax Number:
619-528-4625
Provider Enumeration Date:
05/26/2006