Provider First Line Business Practice Location Address:
SWRMC 3601 WOMBLE ST
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:
619-556-6641
Provider Business Practice Location Address Fax Number:
619-556-9617
Provider Enumeration Date:
04/09/2009