Provider First Line Business Practice Location Address:
5201 RUFFIN RD STE A
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:
92123-1699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-495-5112
Provider Business Practice Location Address Fax Number:
858-694-3987
Provider Enumeration Date:
02/21/2007