Provider First Line Business Practice Location Address:
3855 HEALTH SCIENCES DRIVE
Provider Second Line Business Practice Location Address:
MAIL CODE 0987
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92093-0987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-822-6440
Provider Business Practice Location Address Fax Number:
858-822-6287
Provider Enumeration Date:
10/24/2006