Provider First Line Business Practice Location Address: 
DR. MARY E. WALKER CENTER
    Provider Second Line Business Practice Location Address: 
BLDG 170
    Provider Business Practice Location Address City Name: 
FORT IRWIN
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
92310
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
760-380-7475
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/10/2006