Provider First Line Business Practice Location Address:
3350 LA JOLLA VILLAGE DR
Provider Second Line Business Practice Location Address:
VASDHCS, SCI OT 128T
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92161-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-642-3861
Provider Business Practice Location Address Fax Number:
858-642-1448
Provider Enumeration Date:
05/13/2006