Provider First Line Business Practice Location Address:
2240 E. WINROW AVE.
Provider Second Line Business Practice Location Address:
USA MEDDAC, RWBAHC, ATTN: MI STUDENT CLINIC
Provider Business Practice Location Address City Name:
FT. HUACHUCA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85613-7079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-533-6709
Provider Business Practice Location Address Fax Number:
520-533-6712
Provider Enumeration Date:
02/01/2006