Provider First Line Business Practice Location Address: 
GRAFENHOEWR ARMY HEALTH CLINIC, BUILDING 475
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
APO
    Provider Business Practice Location Address State Name: 
AE
    Provider Business Practice Location Address Postal Code: 
09114-0086
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
907-451-9938
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/14/2008