Provider First Line Business Practice Location Address:
BLDG H100, SANTA MARGARITA ROAD
Provider Second Line Business Practice Location Address:
ATTN: CODE CS-PA
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:
858-725-1813
Provider Business Practice Location Address Fax Number:
858-725-1827
Provider Enumeration Date:
08/22/2005