Provider First Line Business Practice Location Address:
9500 GILMAN DRIVE
Provider Second Line Business Practice Location Address:
UC SAN DIEGO, MC 0663
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92093-0663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-822-6563
Provider Business Practice Location Address Fax Number:
858-534-0409
Provider Enumeration Date:
07/09/2006