Provider First Line Business Practice Location Address:
200 W ARBOR DRIVE
Provider Second Line Business Practice Location Address:
UNIVERSITY OF CALIFORNIA SAN DIEGO
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-8770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-522-8961
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2006