Provider First Line Business Practice Location Address:
2564 STATE ST
Provider Second Line Business Practice Location Address:
STE 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:
760-822-4877
Provider Business Practice Location Address Fax Number:
760-842-1313
Provider Enumeration Date:
09/05/2006