Provider First Line Business Practice Location Address:
3350 LA JOLLLA VILLAGE DRIVE, SUITE 112D
Provider Second Line Business Practice Location Address:
VA SAN DIEGO HEALTHCARE SYSTEM
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:
858-642-3841
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2006