Provider First Line Business Practice Location Address:
65TH MED BDE FHP& PM - OHS USAMEDDAC- K
Provider Second Line Business Practice Location Address:
UNIT #15281
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205-5281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-736-7565
Provider Business Practice Location Address Fax Number:
315-736-3028
Provider Enumeration Date:
11/17/2011