Provider First Line Business Practice Location Address:
FHP-PREVENTIVE MEDICINE, OHS
Provider Second Line Business Practice Location Address:
UNIT #15281
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205-5281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-736-8513
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2011