Provider First Line Business Practice Location Address:
BAACH, 121ST CSH/USAMEDDAC-K
Provider Second Line Business Practice Location Address:
UNIT # 15244
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:
315-737-1751
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2012