Provider First Line Business Practice Location Address:
56TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
7219 LITCHFIELD ROAD
Provider Business Practice Location Address City Name:
LUKE AIR FORCE BASE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85309-1525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-856-4032
Provider Business Practice Location Address Fax Number:
623-856-8803
Provider Enumeration Date:
10/11/2005