Provider First Line Business Practice Location Address:
USS INDEPENDENCE LCS 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96668-0103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-556-3294
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2010