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:
AR
Provider Business Practice Location Address Postal Code:
92055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-3213
Provider Business Practice Location Address Fax Number:
760-725-8223
Provider Enumeration Date:
01/28/2008