Provider First Line Business Practice Location Address:
CLR-25 AID STATION
Provider Second Line Business Practice Location Address:
PSC BOX 20125
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-451-5125
Provider Business Practice Location Address Fax Number:
910-451-0698
Provider Enumeration Date:
01/29/2007