Provider First Line Business Practice Location Address:
2ND RECON BLDG A-71 COURTHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
AA
Provider Business Practice Location Address Postal Code:
28547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-376-7423
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2025