Provider First Line Business Practice Location Address:
NMC SD MERCY DET
Provider Second Line Business Practice Location Address:
3395 STURTEVANT ST SUITE 1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92136-5075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-410-0586
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2007