Provider First Line Business Practice Location Address:
3704 RUFFIN RD BLDG B
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:
92123-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-705-6130
Provider Business Practice Location Address Fax Number:
858-400-4084
Provider Enumeration Date:
08/28/2026