Provider First Line Business Practice Location Address:
BRANCH MEDICAL CLINIC
Provider Second Line Business Practice Location Address:
MARINE CORPS AIR STATION, MIRAMAR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92145-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-577-9944
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2005