Provider First Line Business Practice Location Address:
MARINE CORPS BASE HAWAII
Provider Second Line Business Practice Location Address:
1ST BATTALION, 12TH MARINES
Provider Business Practice Location Address City Name:
KANEOHE BAY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-257-1881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007