Provider First Line Business Practice Location Address:
2450 CRAVEN ST BLDG 3300
Provider Second Line Business Practice Location Address:
NAVAL HEALTH CLINIC NAVAL STATION SAN DIEGO
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92136-5599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-556-5936
Provider Business Practice Location Address Fax Number:
619-556-9419
Provider Enumeration Date:
08/18/2005