Provider First Line Business Practice Location Address:
BLDG H100, SANTA MARGARITA ROAD
Provider Second Line Business Practice Location Address:
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:
760-725-6641
Provider Business Practice Location Address Fax Number:
760-725-0083
Provider Enumeration Date:
08/18/2005