Provider First Line Business Practice Location Address:
H100 SANTA MARGARITA ROAD
Provider Second Line Business Practice Location Address:
ATTENTION: CODE 00QM
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-2903
Provider Business Practice Location Address Fax Number:
760-725-1267
Provider Enumeration Date:
11/07/2012