Provider First Line Business Practice Location Address:
121ST GENERAL HOSPITAL
Provider Second Line Business Practice Location Address:
UNIT 15244
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205-0017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
01182279177984
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2009