Provider First Line Business Practice Location Address:
4077 5TH AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF MEDICAL EDUCATION, MER 35
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-686-3444
Provider Business Practice Location Address Fax Number:
619-260-7305
Provider Enumeration Date:
10/17/2006