Provider First Line Business Practice Location Address:
3939 RUFFIN RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-380-4185
Provider Business Practice Location Address Fax Number:
858-609-6651
Provider Enumeration Date:
11/16/2011