Provider First Line Business Practice Location Address:
3140 EL CAMINO REAL
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:
92008-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-720-9898
Provider Business Practice Location Address Fax Number:
760-720-1636
Provider Enumeration Date:
11/28/2012