Provider First Line Business Practice Location Address:
3959 RUFFIN RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-5570
Provider Business Practice Location Address Fax Number:
858-279-5303
Provider Enumeration Date:
02/19/2009