Provider First Line Business Practice Location Address:
CLB-1 HEADQUARTERS COMPANY
Provider Second Line Business Practice Location Address:
BOX 555737
Provider Business Practice Location Address City Name:
CAMP PENDELTON
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:
760-725-6821
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2009