Provider First Line Business Practice Location Address:
116B PSYCHOLOGY SERVICE
Provider Second Line Business Practice Location Address:
3350 LAJOLLA VILLAGE DRIVE
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92161-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-642-7563
Provider Business Practice Location Address Fax Number:
858-552-7414
Provider Enumeration Date:
09/20/2006