Provider First Line Business Practice Location Address:
2801 JEFFERSON 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:
92008-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-729-4952
Provider Business Practice Location Address Fax Number:
760-729-2738
Provider Enumeration Date:
07/06/2006