Provider First Line Business Practice Location Address:
3939 RUFFIN RD
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:
92123-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-948-8464
Provider Business Practice Location Address Fax Number:
858-756-9012
Provider Enumeration Date:
08/03/2006