Provider First Line Business Practice Location Address:
2051 CUSHING RD
Provider Second Line Business Practice Location Address:
NAVAL BRANCH HEALTH CLINIC, NTC
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92106-6173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-524-5720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2011