Provider First Line Business Practice Location Address:
141 12TH ARMOR DIVISION AVE
Provider Second Line Business Practice Location Address:
BLDG 1480
Provider Business Practice Location Address City Name:
FORT KNOX
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40121-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-626-6204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2007