Provider First Line Business Practice Location Address:
COMMANDING OFFICER USS LA JOLLA SSN 701
Provider Second Line Business Practice Location Address:
ATTN MED DEPT
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96671-2381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-471-5002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2006