Provider First Line Business Practice Location Address:
355TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
280 FIRST STREET, BLDG 23
Provider Business Practice Location Address City Name:
DAVIS MONTHAN AFB
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85707-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-228-2615
Provider Business Practice Location Address Fax Number:
520-228-2627
Provider Enumeration Date:
05/01/2007