Provider First Line Business Practice Location Address:
3350 VILLA LA JOLLA DR
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:
858-534-4020
Provider Business Practice Location Address Fax Number:
858-552-7404
Provider Enumeration Date:
07/30/2006