Provider First Line Business Practice Location Address:
19871 BAUER RD
Provider Second Line Business Practice Location Address:
BRANCH MEDICAL CLINIC, 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:
92145-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-577-9900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2006