Provider First Line Business Practice Location Address:
1458 4TH ST MCAGCC/ MAGTFTC
Provider Second Line Business Practice Location Address:
7TH MARINE REGIMENTAL AID STATION
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-830-7876
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2005