Provider First Line Business Practice Location Address:
HQCO 1ST MAR ATTN MEDICAL
Provider Second Line Business Practice Location Address:
BOX 555402
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-0096
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2005