Provider First Line Business Practice Location Address:
1425 PORTER ST
Provider Second Line Business Practice Location Address:
USAMRIID
Provider Business Practice Location Address City Name:
FORT DETRICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-619-4996
Provider Business Practice Location Address Fax Number:
301-619-2511
Provider Enumeration Date:
10/12/2005