Provider First Line Business Practice Location Address:
34520 BOB WILSON DR
Provider Second Line Business Practice Location Address:
DERMATOLOGY DEPARTMENT, NAVAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92134-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-532-9666
Provider Business Practice Location Address Fax Number:
619-532-9458
Provider Enumeration Date:
09/20/2005