Provider First Line Business Practice Location Address: 
NAVAL HOSPITAL GUAM
    Provider Second Line Business Practice Location Address: 
BLDG 50 FAHRENHOLT
    Provider Business Practice Location Address City Name: 
AGANA HEIGHTS
    Provider Business Practice Location Address State Name: 
GU
    Provider Business Practice Location Address Postal Code: 
96910
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
671-344-9765
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/06/2009