Provider First Line Business Practice Location Address:
4617 RUFFNER ST STE 200
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:
92111-2284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-268-1006
Provider Business Practice Location Address Fax Number:
858-268-5097
Provider Enumeration Date:
12/31/2006