Provider First Line Business Practice Location Address:
2236 ENCINITAS BLVD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-4352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-479-2420
Provider Business Practice Location Address Fax Number:
760-479-2454
Provider Enumeration Date:
05/24/2007