Provider First Line Business Practice Location Address:
3350 VIA LA JOLLA
Provider Second Line Business Practice Location Address:
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:
619-400-5202
Provider Business Practice Location Address Fax Number:
619-400-5154
Provider Enumeration Date:
08/10/2006