Provider First Line Business Practice Location Address:
30 NIGHTINGALE RD
Provider Second Line Business Practice Location Address:
BLDG 5525
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:
661-275-2634
Provider Business Practice Location Address Fax Number:
661-277-6645
Provider Enumeration Date:
01/23/2006