Provider First Line Business Practice Location Address:
4565 RUFFNER ST STE 101
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:
92111-2258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-717-4196
Provider Business Practice Location Address Fax Number:
858-724-3800
Provider Enumeration Date:
05/08/2007