Provider First Line Business Practice Location Address: 
UNIT 29623, BOX 0059
    Provider Second Line Business Practice Location Address: 
WIESBADEN HEALTH CLINIC (ATTN: OPTOMETRY CLINIC)
    Provider Business Practice Location Address City Name: 
APO
    Provider Business Practice Location Address State Name: 
AE
    Provider Business Practice Location Address Postal Code: 
09096
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
0114915114264029
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/10/2009