Provider First Line Business Practice Location Address:
BAUMHOLDER HEALTH CLINIC - UNIT 23809
Provider Second Line Business Practice Location Address:
CMR 405 BOX #52
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
490678366357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2010