Provider First Line Business Practice Location Address:
75TH MEDICAL COMPANY(AS)
Provider Second Line Business Practice Location Address:
BOX #7, UNIT 15190
Provider Business Practice Location Address City Name:
PYONGTAEK
Provider Business Practice Location Address State Name:
APO
Provider Business Practice Location Address Postal Code:
AP
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
05057538125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2009