Provider First Line Business Practice Location Address:
1060 GAFFNEY RD
Provider Second Line Business Practice Location Address:
COMMANDER,USA-MEDDAC-AK,ATTN:MCUC-MMD-QM
Provider Business Practice Location Address City Name:
FT WAINWRIGHT
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99703-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-353-5418
Provider Business Practice Location Address Fax Number:
907-353-4845
Provider Enumeration Date:
01/30/2006