Provider First Line Business Practice Location Address:
4655 RUFFNER ST STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO, CA 92111
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-650-6660
Provider Business Practice Location Address Fax Number:
760-650-6660
Provider Enumeration Date:
06/14/2013