Provider First Line Business Practice Location Address:
850 PROSPECT ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-4208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-454-6124
Provider Business Practice Location Address Fax Number:
858-459-8908
Provider Enumeration Date:
01/08/2007