Provider First Line Business Practice Location Address:
1800 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92083-7700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-631-7914
Provider Business Practice Location Address Fax Number:
760-631-7915
Provider Enumeration Date:
10/26/2006