Provider First Line Business Practice Location Address:
NAVAL BASE SAN DIEGO 2450 CRAVEN STREET #3300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92136-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-631-8595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2020