Provider First Line Business Practice Location Address:
NBHC NAVAL BASE CORONADO
Provider Second Line Business Practice Location Address:
BLDG. 601
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92135-7046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-545-4359
Provider Business Practice Location Address Fax Number:
619-545-0452
Provider Enumeration Date:
04/14/2014