Provider First Line Business Practice Location Address:
338 S DAKOTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANDENBERG AFB
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93437-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-606-3012
Provider Business Practice Location Address Fax Number:
805-606-4474
Provider Enumeration Date:
11/28/2005