Provider First Line Business Practice Location Address:
LANGFORD LAKE RD
Provider Second Line Business Practice Location Address:
BLDG 918
Provider Business Practice Location Address City Name:
FT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-386-4019
Provider Business Practice Location Address Fax Number:
760-386-4300
Provider Enumeration Date:
01/14/2016