Provider First Line Business Practice Location Address:
280 1ST ST
Provider Second Line Business Practice Location Address:
49 MEDICAL GROUP
Provider Business Practice Location Address City Name:
HOLLOMAN AIR FORCE BASE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88330-8273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-572-7238
Provider Business Practice Location Address Fax Number:
505-572-3057
Provider Enumeration Date:
10/01/2006