Provider First Line Business Practice Location Address: 
US NAVAL HOSPITAL GUAM
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
FPO
    Provider Business Practice Location Address State Name: 
AP
    Provider Business Practice Location Address Postal Code: 
96540
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
671-344-9543
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/24/2014