Provider First Line Business Practice Location Address:
A CO 121ST COMBAT SUPPORT HOSPITAL
Provider Second Line Business Practice Location Address:
BOX 752
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-619-4124
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2008