Provider First Line Business Practice Location Address:
USA MEDDAC; ATTN: CREDENTIALS
Provider Second Line Business Practice Location Address:
11505 MT BELEVEDERE BLVD
Provider Business Practice Location Address City Name:
FT. DRUM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13602-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-772-4025
Provider Business Practice Location Address Fax Number:
315-772-9498
Provider Enumeration Date:
11/10/2005