Provider First Line Business Practice Location Address: 
473 CABRILLO ST.
    Provider Second Line Business Practice Location Address: 
SUITE A1A U.S. ARMY HEALTH CLINIC
    Provider Business Practice Location Address City Name: 
MONTEREY
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93944-3208
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
831-242-7581
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/10/2006