Provider First Line Business Practice Location Address:
NAVAL HOSPITAL BLDG H100, SANTA MARGARITA RD
Provider Second Line Business Practice Location Address:
ATTN: CODE CS-PA
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-1511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2005