Provider First Line Business Practice Location Address:
2525 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
PLAZA CAMINO REAL - CARLSBAD MALL STE. 101B
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-729-7957
Provider Business Practice Location Address Fax Number:
760-729-3295
Provider Enumeration Date:
12/27/2006