Provider First Line Business Practice Location Address:
2524 LA COSTA AVE
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:
92009-7321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-436-2567
Provider Business Practice Location Address Fax Number:
760-436-2022
Provider Enumeration Date:
12/19/2006