Provider First Line Business Practice Location Address:
338 S DAKOTA AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANDENBERG AFB
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-606-5521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2005