Provider First Line Business Practice Location Address:
MAIN EXCHANGE COMPLEX, BLDG 1103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-722-6121
Provider Business Practice Location Address Fax Number:
619-722-6389
Provider Enumeration Date:
08/06/2008