Provider First Line Business Practice Location Address: 
1 JARRETT WHITE RD
    Provider Second Line Business Practice Location Address: 
TRIPLER ARMY MEDICAL CENTER ATTN:MCHK-QS
    Provider Business Practice Location Address City Name: 
TRIPLER AMC
    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: 
808-433-2460
    Provider Business Practice Location Address Fax Number: 
808-433-1558
    Provider Enumeration Date: 
01/05/2006