Provider First Line Business Practice Location Address: 
UCSD COUNSELING AND PSYC SERVICES
    Provider Second Line Business Practice Location Address: 
9500 GILMAN DRIVE
    Provider Business Practice Location Address City Name: 
LA JOLLA
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
92092-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
858-534-9179
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/10/2008