Provider First Line Business Practice Location Address:
5TH MARINE REGIMENT, FIRST MARINE DIVISION
Provider Second Line Business Practice Location Address:
62 ABMC/BULIDING 620305 8TH STREET CAMP SAN MATEO
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:
760-725-0025
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2006