Provider First Line Business Practice Location Address:
4405 VANDEVER AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF NEUROLOGY
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-528-5000
Provider Business Practice Location Address Fax Number:
619-516-6598
Provider Enumeration Date:
12/08/2006