Provider First Line Business Practice Location Address:
35TH & DESERT STORM
Provider Second Line Business Practice Location Address:
BLDG 5980
Provider Business Practice Location Address City Name:
FORT CAMPBELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-412-6027
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2008