Provider First Line Business Practice Location Address: 
1950 CALLE BARCELONA
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CARLSBAD
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
92009
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
866-422-7053
    Provider Business Practice Location Address Fax Number: 
866-789-8027
    Provider Enumeration Date: 
03/30/2007