Provider First Line Business Practice Location Address:
BOX 555657
Provider Second Line Business Practice Location Address:
1ST MEDICAL BATTALION 1ST MARINE LOGISTICS GROUP
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:
619-752-0215
Provider Business Practice Location Address Fax Number:
510-721-0968
Provider Enumeration Date:
01/07/2019