Provider First Line Business Practice Location Address:
3626 RUFFIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-565-9666
Provider Business Practice Location Address Fax Number:
858-565-9441
Provider Enumeration Date:
07/06/2006