Provider First Line Business Practice Location Address:
BOX 105109
Provider Second Line Business Practice Location Address:
U.S. ARMY MEDICAL ACTIVITY
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:
760-380-3116
Provider Business Practice Location Address Fax Number:
760-380-6294
Provider Enumeration Date:
04/11/2006