Provider First Line Business Practice Location Address:
5395 RUFFIN RD
Provider Second Line Business Practice Location Address:
STE 103B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-505-0400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006