Provider First Line Business Practice Location Address:
DEPT OF FAMILY & PREVENTIVE MEDICINE
Provider Second Line Business Practice Location Address:
9500 GILMAN DRIVE - MC-0811
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92093-0811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-534-9540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2012