Provider First Line Business Practice Location Address:
2803 MEDICAL CAMPUS DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEYMOUR JOHNSON AFB
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
27531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-747-4460
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2012