Provider First Line Business Practice Location Address:
3210 PIRAGUA ST
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:
92009-7839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-943-1161
Provider Business Practice Location Address Fax Number:
760-943-0089
Provider Enumeration Date:
10/16/2006