Provider First Line Business Practice Location Address:
123 TURNER LANE
Provider Second Line Business Practice Location Address:
LBJ TROPICAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
PAGO PAGO
Provider Business Practice Location Address State Name:
AS
Provider Business Practice Location Address Postal Code:
96799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
684-633-1683
Provider Business Practice Location Address Fax Number:
684-633-1976
Provider Enumeration Date:
08/26/2005