Provider First Line Business Practice Location Address:
BUILDING 1333
Provider Second Line Business Practice Location Address:
AREA 13
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-385-0096
Provider Business Practice Location Address Fax Number:
760-385-4185
Provider Enumeration Date:
11/17/2006