Provider First Line Business Practice Location Address:
5625 RUFFIN RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-576-9501
Provider Business Practice Location Address Fax Number:
858-576-1581
Provider Enumeration Date:
07/20/2006