Provider First Line Business Practice Location Address:
35000 GUADALCANAL AVE
Provider Second Line Business Practice Location Address:
BRANCH MEDICAL CLINIC, MCRD BLD 596
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92140-5599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-524-0789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2006