Provider First Line Business Practice Location Address:
550 POPE AVENUE
Provider Second Line Business Practice Location Address:
MUNSON ARMY HEALTH CENTER(ATTN: MCXN-COD, MR. KENNEDY)
Provider Business Practice Location Address City Name:
FORT. LEAVENWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66027-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-684-6143
Provider Business Practice Location Address Fax Number:
913-684-6208
Provider Enumeration Date:
11/05/2009