Provider First Line Business Practice Location Address:
95TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
30 NIGHTINGALE RD
Provider Business Practice Location Address City Name:
EDWARDS AFB
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93524-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-275-2749
Provider Business Practice Location Address Fax Number:
661-275-4365
Provider Enumeration Date:
10/20/2005