Provider First Line Business Practice Location Address:
300 W HOSPITAL RD
Provider Second Line Business Practice Location Address:
EISENHOWER ARMY MEDICAL CENTER, ASAP, 12-W
Provider Business Practice Location Address City Name:
FORT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905-5741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-5505
Provider Business Practice Location Address Fax Number:
706-787-0105
Provider Enumeration Date:
12/13/2006