Provider First Line Business Practice Location Address:
233 F ST TRLR 318-H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28547-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-450-5480
Provider Business Practice Location Address Fax Number:
910-449-8409
Provider Enumeration Date:
06/21/2011