Provider First Line Business Practice Location Address:
2D RECONNAISSANCE BN, 2D MARINE DIVISION BLDG A-71
Provider Second Line Business Practice Location Address:
PSC BOX 20138
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542-0138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-825-6648
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2012