Provider First Line Business Practice Location Address:
BDAACH/549TH HC
Provider Second Line Business Practice Location Address:
USAG CAMP HUMPHREYS, BLDG. # 3030
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96271-0017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-373-1144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2018