Provider First Line Business Practice Location Address:
3702 RUFFIN RD STE 100
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:
92123-1893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-4300
Provider Business Practice Location Address Fax Number:
619-297-4300
Provider Enumeration Date:
01/02/2018