Provider First Line Business Practice Location Address:
MEDICAL DEPARTMENT
Provider Second Line Business Practice Location Address:
USS BONHOMME RICHARD LHD-6 FPO AP 96617-1656
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96617-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-556-4771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006