Provider First Line Business Practice Location Address:
4565 RUFFNER ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-892-9092
Provider Business Practice Location Address Fax Number:
858-268-9810
Provider Enumeration Date:
02/22/2010