Provider First Line Business Practice Location Address:
2ND BN 9TH MAR, 2ND MARINE DIVISION
Provider Second Line Business Practice Location Address:
PSC 20002
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-450-9434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2007