Provider First Line Business Practice Location Address:
MARINE CORPS BASE - CAMP LEJEUNE
Provider Second Line Business Practice Location Address:
460 BLDG JULIAN C. SMITH BLVD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-451-1013
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2005