Provider First Line Business Practice Location Address:
850 PROSPECT ST STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-4208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-454-2656
Provider Business Practice Location Address Fax Number:
858-454-1069
Provider Enumeration Date:
07/27/2006