Provider First Line Business Practice Location Address:
5776 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:
92123-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-1144
Provider Business Practice Location Address Fax Number:
858-268-5145
Provider Enumeration Date:
07/18/2006