Provider First Line Business Practice Location Address:
9888 GENESEE AVE
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:
92037-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-587-2223
Provider Business Practice Location Address Fax Number:
858-834-1798
Provider Enumeration Date:
09/07/2026