Provider First Line Business Practice Location Address:
C CO 168TH MED BN (AS)
Provider Second Line Business Practice Location Address:
UNIT#15190
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
PYONGTAEK
Provider Business Practice Location Address Postal Code:
96271
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
7538122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2005