Provider First Line Business Practice Location Address:
5395 RUFFIN RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-571-3630
Provider Business Practice Location Address Fax Number:
858-571-3649
Provider Enumeration Date:
12/28/2012