Provider First Line Business Practice Location Address:
3RDLARBN, H&S COMPANY, MEDICAL BAS
Provider Second Line Business Practice Location Address:
MCGACC 29 PALMS, 1STMARDIVDET
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92278-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-830-6062
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2008