Provider First Line Business Practice Location Address:
MCRD SAN DIEGO
Provider Second Line Business Practice Location Address:
3800 CHOSIN AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-466-5161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2018