Provider First Line Business Practice Location Address:
2D RECONNAISSANCE BATTALION AID STATION
Provider Second Line Business Practice Location Address:
A-17 COURTHOUSE BAY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-231-1136
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2021