Provider First Line Business Practice Location Address:
9500 GILMAN DRIVE MC 0985
Provider Second Line Business Practice Location Address:
UNIVERSITY OF CALIFORNIA SAN DIEGO
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-534-8037
Provider Business Practice Location Address Fax Number:
858-534-6727
Provider Enumeration Date:
06/22/2006