Provider First Line Business Practice Location Address:
VA SAN DIEGO
Provider Second Line Business Practice Location Address:
3350 LA JOLLA VILLAGE DR, SPID S 118
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92161-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-642-3186
Provider Business Practice Location Address Fax Number:
858-552-4311
Provider Enumeration Date:
07/16/2006