Provider First Line Business Practice Location Address:
EXPEDITIONARY HEALTH SERVICES BLDG 116
Provider Second Line Business Practice Location Address:
3985 CUMMINGS RD. SUITE 4
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92136-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-556-1436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2010