Provider First Line Business Practice Location Address:
3350 LA JOLLA VILLAGE DRIVE
Provider Second Line Business Practice Location Address:
MAILCODE 122
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-642-1404
Provider Business Practice Location Address Fax Number:
858-552-7455
Provider Enumeration Date:
09/15/2006