Provider First Line Business Practice Location Address:
528TH MEDICAL DETACHMENT, (CSC)
Provider Second Line Business Practice Location Address:
BLDG 1-2732, KNOX HALL
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-907-1997
Provider Business Practice Location Address Fax Number:
910-907-3978
Provider Enumeration Date:
08/26/2006