Provider First Line Business Practice Location Address:
3350 LA JOLLA VILLAGE DR.
Provider Second Line Business Practice Location Address:
C/O VA HEALTHCARE SYSTEM - SWS 122
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-646-2852
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2013