Provider First Line Business Practice Location Address:
PSC BOX 20183
Provider Second Line Business Practice Location Address:
2D MARINE SPECIAL OPERATIONS BATTALION
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542-0116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-440-7704
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2011