Provider First Line Business Practice Location Address:
2945 HARDING ST
Provider Second Line Business Practice Location Address:
STE. 110
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-613-9136
Provider Business Practice Location Address Fax Number:
760-942-7236
Provider Enumeration Date:
07/11/2006