Provider First Line Business Practice Location Address:
SANTA MARGARITA RD BLDG H100
Provider Second Line Business Practice Location Address:
ATTN: CODE CS-PA
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-1244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2005