Provider First Line Business Practice Location Address:
NMCSD BRANCH DENTAL CLINIC 32ND
Provider Second Line Business Practice Location Address:
2310 CRAVEN STREET
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:
619-556-8218
Provider Business Practice Location Address Fax Number:
619-556-9410
Provider Enumeration Date:
07/24/2012