Provider First Line Business Practice Location Address:
300 E HOSPITAL RD.
Provider Second Line Business Practice Location Address:
DWIGHT D EISENHOWER ARMY MEDICAL CENTER
Provider Business Practice Location Address City Name:
FT. GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-3656
Provider Business Practice Location Address Fax Number:
706-787-8081
Provider Enumeration Date:
11/21/2006