Provider First Line Business Practice Location Address:
5675 RUFFIN ROAD,
Provider Second Line Business Practice Location Address:
SUITE 325
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-467-9170
Provider Business Practice Location Address Fax Number:
858-467-9183
Provider Enumeration Date:
10/20/2006