Provider First Line Business Practice Location Address:
BLDG 110, 6TH AVENUE
Provider Second Line Business Practice Location Address:
US ARMY AEROMEDICAL ACTIVITY
Provider Business Practice Location Address City Name:
FORT RUCKER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-255-0749
Provider Business Practice Location Address Fax Number:
334-255-0747
Provider Enumeration Date:
11/02/2005