Provider First Line Business Practice Location Address:
3402 TARAWA RD.
Provider Second Line Business Practice Location Address:
SPECIAL BOAT TEAM TWELVE MEDICAL DEPARTMENT
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92155-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-437-5540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2008