Provider First Line Business Practice Location Address:
MCXK-ADP, BLDG 170
Provider Second Line Business Practice Location Address:
RM 515
Provider Business Practice Location Address City Name:
FORT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-380-4074
Provider Business Practice Location Address Fax Number:
760-380-6469
Provider Enumeration Date:
07/21/2006