Provider First Line Business Practice Location Address:
459 9TH CAVALRY REGIMENT AVE
Provider Second Line Business Practice Location Address:
BLDG 503
Provider Business Practice Location Address City Name:
FORT KNOX
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40121-5282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-624-2981
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006