Provider First Line Business Practice Location Address:
19871 MITSCHER WAY
Provider Second Line Business Practice Location Address:
MCAS MIRAMAR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-577-7857
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2005