Provider First Line Business Practice Location Address:
HHC 121ST GENERAL HOSPITAL
Provider Second Line Business Practice Location Address:
BOX 355
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
736
Provider Business Practice Location Address Fax Number:
7384432
Provider Enumeration Date:
10/19/2005