Provider First Line Business Practice Location Address:
3656 RUFFIN RD STE A
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:
92123-1837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-541-0000
Provider Business Practice Location Address Fax Number:
858-541-2011
Provider Enumeration Date:
03/15/2011