Provider First Line Business Practice Location Address:
6424 LA JOLLA SCENIC DR S
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:
92037-6445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-452-3882
Provider Business Practice Location Address Fax Number:
858-452-3992
Provider Enumeration Date:
07/28/2006