Provider First Line Business Practice Location Address:
95TH MEDICAL GROUP/SGOHF
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:
661-277-5292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2006