Provider First Line Business Practice Location Address:
NAVY AIR STATION NORTH ISLAND
Provider Second Line Business Practice Location Address:
BLD #2017
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-313-2088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2019