Provider First Line Business Practice Location Address:
HHC 121ST GEN HOSPITAL
Provider Second Line Business Practice Location Address:
BOX #23 UNIT 15244
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96204-0017
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
904-322-8495
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006