Provider First Line Business Practice Location Address:
CLR-17 RAS, 1ST MLG
Provider Second Line Business Practice Location Address:
BLDG 14030
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-6180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2007