Provider First Line Business Practice Location Address:
NSWG1 LOGSU MEDICAL SPORTS MEDICINE
Provider Second Line Business Practice Location Address:
3632 GUADALCANAL RD - BLDG #165
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92155-5583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-537-3264
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2015