Provider First Line Business Practice Location Address:
1301 NORTH WAREHOUSE RD
Provider Second Line Business Practice Location Address:
USDB-DTP
Provider Business Practice Location Address City Name:
FT LEAVENWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-758-3751
Provider Business Practice Location Address Fax Number:
913-758-3754
Provider Enumeration Date:
10/19/2006