Provider First Line Business Practice Location Address:
7219 N LITCHFIELD ROAD
Provider Second Line Business Practice Location Address:
56 MEDICAL GROUP
Provider Business Practice Location Address City Name:
LUKE AFB
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85309-1525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-856-7579
Provider Business Practice Location Address Fax Number:
623-856-4433
Provider Enumeration Date:
10/10/2008