Provider First Line Business Practice Location Address:
3625 RUFFIN RD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-864-8769
Provider Business Practice Location Address Fax Number:
858-244-1807
Provider Enumeration Date:
11/26/2010