Provider First Line Business Practice Location Address:
VA MEDICAL CTR
Provider Second Line Business Practice Location Address:
3350 LA JOLLA VILLAGE DR
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:
858-642-1174
Provider Business Practice Location Address Fax Number:
858-552-7485
Provider Enumeration Date:
07/31/2006