Provider First Line Business Practice Location Address:
VETERANS ADMINISTRATION MEDICAL CTR
Provider Second Line Business Practice Location Address:
3350 LA JOLLA VILLAGE DRIVE (112J)
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92161-8892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-552-8585
Provider Business Practice Location Address Fax Number:
858-552-7530
Provider Enumeration Date:
02/13/2006