Provider First Line Business Practice Location Address:
9434 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
MAIL CODE 7892
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-657-7174
Provider Business Practice Location Address Fax Number:
858-657-5058
Provider Enumeration Date:
01/23/2017