Provider First Line Business Practice Location Address:
INNER LOOP ROAD
Provider Second Line Business Practice Location Address:
BLDG. 166
Provider Business Practice Location Address City Name:
FORT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310-5056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-380-4014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2006