Provider First Line Business Practice Location Address:
14TH STREET
Provider Second Line Business Practice Location Address:
BUILDING 13128
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-5208
Provider Business Practice Location Address Fax Number:
760-725-5779
Provider Enumeration Date:
12/24/2007