Provider First Line Business Practice Location Address:
BOX 555020
Provider Second Line Business Practice Location Address:
BLDG 1103, MAIN EXCHANGE COMPLEX
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-722-6121
Provider Business Practice Location Address Fax Number:
619-722-6389
Provider Enumeration Date:
05/17/2007