Provider First Line Business Practice Location Address:
95 AMDS/SGP
Provider Second Line Business Practice Location Address:
55 N. WOLFE AVE.
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:
661-277-1130
Provider Business Practice Location Address Fax Number:
661-277-0688
Provider Enumeration Date:
04/11/2006