Provider First Line Business Practice Location Address:
4837 S PHOENIX ST.
Provider Second Line Business Practice Location Address:
RM 119 DAVIS-MONTHAN AIR FORCE BASE
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-228-1860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2009