Provider First Line Business Practice Location Address:
HHC ,18TH MEDCOM
Provider Second Line Business Practice Location Address:
BOX 729, UNIT 15244
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:
11-822-7917
Provider Business Practice Location Address Fax Number:
01182279175029
Provider Enumeration Date:
01/15/2007