Provider First Line Business Practice Location Address:
1300 MANCHEROL DRIVE
Provider Second Line Business Practice Location Address:
#C, GENESISICARE PLUS
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-871-0705
Provider Business Practice Location Address Fax Number:
760-871-0717
Provider Enumeration Date:
03/29/2006