Provider First Line Business Practice Location Address:
3939 RUFFIN RD
Provider Second Line Business Practice Location Address:
SUITE 102
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:
858-810-0375
Provider Business Practice Location Address Fax Number:
858-633-0376
Provider Enumeration Date:
03/16/2010