Provider First Line Business Practice Location Address:
BLDG H 2005 KNIGHT LANE
Provider Second Line Business Practice Location Address:
NAVY MEDICINE SUPPORT COMMAND ATTN:MEDICAL STAFF SVCS
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32212-0140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-5102
Provider Business Practice Location Address Fax Number:
760-763-6510
Provider Enumeration Date:
01/17/2006