Provider First Line Business Practice Location Address:
USA MEDDAC-B ATTN: CREDENTIALS OFFICE
Provider Second Line Business Practice Location Address:
CMR BLDG 700, ROOM 59
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-590-2368
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2023