Provider First Line Business Practice Location Address:
4542 RUFFNER ST STE 130
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:
92111-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-289-7757
Provider Business Practice Location Address Fax Number:
619-353-0553
Provider Enumeration Date:
07/07/2022