Provider First Line Business Practice Location Address:
BLDG 111 C ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542-0084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-451-7821
Provider Business Practice Location Address Fax Number:
910-451-7821
Provider Enumeration Date:
07/02/2007