Provider First Line Business Practice Location Address:
121ST GENERAL HOSPITAL. BOX#567
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:
96205
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
315-736-6692
Provider Business Practice Location Address Fax Number:
315-736-3028
Provider Enumeration Date:
10/17/2005