Provider First Line Business Practice Location Address:
WOOD PCMH- CAMP WALKER
Provider Second Line Business Practice Location Address:
UNIT 15021
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-403-4543
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2015