Provider First Line Business Practice Location Address:
A STREET
Provider Second Line Business Practice Location Address:
BLDG # RR 440
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542-0117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-440-0011
Provider Business Practice Location Address Fax Number:
910-440-1095
Provider Enumeration Date:
03/14/2012