Provider First Line Business Practice Location Address:
22190 AVENUE E
Provider Second Line Business Practice Location Address:
1ST MEDICAL BATTALION, CLR-15, 1ST MLG, MARFORPAC
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-4912
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2011