Provider First Line Business Practice Location Address:
2125 S EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-6260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-231-1116
Provider Business Practice Location Address Fax Number:
760-231-6429
Provider Enumeration Date:
10/27/2006