Provider First Line Business Practice Location Address:
3675 RUFFIN RD
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-335-8657
Provider Business Practice Location Address Fax Number:
858-534-0595
Provider Enumeration Date:
09/04/2008