Provider First Line Business Practice Location Address: 
1 JARRETT WHITE RD
    Provider Second Line Business Practice Location Address: 
TRIPLER AMC, DEPARTMENT OBGYN ATTN: MCHK-OB
    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: 
808-433-6621
    Provider Business Practice Location Address Fax Number: 
808-433-1552
    Provider Enumeration Date: 
12/27/2005