Provider First Line Business Practice Location Address:
1145 STURGIS RD
Provider Second Line Business Practice Location Address:
ROBERT E BUSH NAVAL HOSPITAL
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-632-6213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2006