Provider First Line Business Practice Location Address:
3939 RUFFIN RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-560-0422
Provider Business Practice Location Address Fax Number:
858-633-0392
Provider Enumeration Date:
02/06/2007