Provider First Line Business Practice Location Address:
3660 RUFFIN RD STE C
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:
92123-1877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-452-1955
Provider Business Practice Location Address Fax Number:
619-701-6657
Provider Enumeration Date:
12/07/2020