Provider First Line Business Practice Location Address:
1670 E. PERIMETER WAY
Provider Second Line Business Practice Location Address:
162ND MEDICAL GROUP/ARIZONA AIR NATIONAL GUARD
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-295-6172
Provider Business Practice Location Address Fax Number:
520-295-6658
Provider Enumeration Date:
04/30/2009