Provider First Line Business Practice Location Address:
4510 EXECUTIVE DR STE 325
Provider Second Line Business Practice Location Address:
UCSD NEUROLOGICAL INSTITUTE, CHANCELLOR PARK, MC 0973
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-3069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-657-8515
Provider Business Practice Location Address Fax Number:
858-657-8557
Provider Enumeration Date:
04/21/2011