Provider First Line Business Practice Location Address:
533020 BASOLINE RD
Provider Second Line Business Practice Location Address:
CAMP HORNO
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-7410
Provider Business Practice Location Address Fax Number:
760-725-7663
Provider Enumeration Date:
01/31/2007