Provider First Line Business Practice Location Address:
300 EAST HOSPITAL ROAD, 13 FLOOR. OBHS
Provider Second Line Business Practice Location Address:
DWIGHT D EISENHOWER ARMY MEDICAL CENTER
Provider Business Practice Location Address City Name:
FORT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905-5650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-2039
Provider Business Practice Location Address Fax Number:
706-787-5625
Provider Enumeration Date:
08/19/2005