Provider First Line Business Practice Location Address:
ISC-7, NHCP
Provider Second Line Business Practice Location Address:
BLDG 2016 SAN JACINTO RD.
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:
760-763-9467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2006