Provider First Line Business Practice Location Address:
BUILDING 130193T A STREET
Provider Second Line Business Practice Location Address:
BOX 55020
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-8301
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2007