Provider First Line Business Practice Location Address:
142 ENCINITAS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-3657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-230-2251
Provider Business Practice Location Address Fax Number:
760-230-2253
Provider Enumeration Date:
07/14/2009