Provider First Line Business Practice Location Address:
412TH MEDICAL GROUP 30 NIGHTINGALE RD.
Provider Second Line Business Practice Location Address:
BUILDING #5525
Provider Business Practice Location Address City Name:
EDWARDS AIR FORCE BASE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-277-7118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2020