Provider First Line Business Practice Location Address:
DDEAMC 300 E HOSPITAL ROAD 13A-10
Provider Second Line Business Practice Location Address:
BLDG. 40701
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-2420
Provider Business Practice Location Address Fax Number:
706-787-8180
Provider Enumeration Date:
12/14/2006