Provider First Line Business Practice Location Address:
4050 SURFACE NAVY BLVD
Provider Second Line Business Practice Location Address:
MUDSU ONE DET-1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92136-5288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-556-6323
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2012