Provider First Line Business Practice Location Address:
347TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
3278 MITCHELL BLVD
Provider Business Practice Location Address City Name:
MOODY A F B
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31699-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-257-3755
Provider Business Practice Location Address Fax Number:
229-257-4672
Provider Enumeration Date:
11/15/2005