Provider First Line Business Practice Location Address:
KADENA AFB 18 MDG
Provider Second Line Business Practice Location Address:
UNIT 5142
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-630-4902
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2010