Provider First Line Business Practice Location Address:
18TH MEDCOM
Provider Second Line Business Practice Location Address:
ATTN: DCCS - AM
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205-0054
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
11-822-7916
Provider Business Practice Location Address Fax Number:
11-822-7917
Provider Enumeration Date:
11/07/2005