Provider First Line Business Practice Location Address:
28 FIRST STREET
Provider Second Line Business Practice Location Address:
49TH MEDICAL GROUP
Provider Business Practice Location Address City Name:
HOLLOMAN AFB
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88330-8035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-572-8273
Provider Business Practice Location Address Fax Number:
575-572-7634
Provider Enumeration Date:
08/06/2009