Provider First Line Business Practice Location Address:
4655 RUFFNER ST
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-787-6787
Provider Business Practice Location Address Fax Number:
800-787-6762
Provider Enumeration Date:
03/29/2007