Provider First Line Business Practice Location Address:
92ND MEDICAL GROUP
Provider Second Line Business Practice Location Address:
200 N. CHENNAULT STE 100
Provider Business Practice Location Address City Name:
FAIRCHILD AFB
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-247-2731
Provider Business Practice Location Address Fax Number:
509-247-4499
Provider Enumeration Date:
11/22/2005