Provider First Line Business Practice Location Address:
56 MEDICAL GROUP
Provider Second Line Business Practice Location Address:
7219 N LITCHFIELD ROAD
Provider Business Practice Location Address City Name:
LUKE AFB
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85309-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-856-3130
Provider Business Practice Location Address Fax Number:
623-856-4379
Provider Enumeration Date:
11/21/2008