Provider First Line Business Practice Location Address:
2386 AVENIDA DE LA PLAYA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-945-7906
Provider Business Practice Location Address Fax Number:
858-754-1202
Provider Enumeration Date:
05/31/2005