Provider First Line Business Practice Location Address:
BUILDING 2000 MCAGCC
Provider Second Line Business Practice Location Address:
CLB-7 BAS
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92278-8280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-830-3750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2007