Provider First Line Business Practice Location Address:
30 NIGHTINGALE RD BLDG 5526
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDWARDS AFB
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93524-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-277-3891
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2012