Provider First Line Business Practice Location Address:
2564 STATE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-1662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-729-4931
Provider Business Practice Location Address Fax Number:
760-729-3846
Provider Enumeration Date:
03/22/2007