Provider First Line Business Practice Location Address:
BRANCH MEDICAL CLINIC
Provider Second Line Business Practice Location Address:
BLDG 60126
Provider Business Practice Location Address City Name:
SAN CLEMENTE ISLAND
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:
619-524-9356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2007