Provider First Line Business Practice Location Address: 
1 JARRETT WHITE RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TRIPLER ARMY MEDICAL CENTER
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96859-5001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-787-3040
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/20/2006