Provider First Line Business Practice Location Address: 
2110 RUTHERFORD RD
    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: 
92008-7328
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
760-516-5136
    Provider Business Practice Location Address Fax Number: 
760-516-6201
    Provider Enumeration Date: 
06/06/2011