Provider First Line Business Practice Location Address:
300 W HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
EISENHOWER ARMY MEDICAL CENTER
Provider Business Practice Location Address City Name:
FORT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905-5650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-2720
Provider Business Practice Location Address Fax Number:
706-787-8176
Provider Enumeration Date:
12/01/2006