Provider First Line Business Practice Location Address:
USA- MEDDAC ATTN: MCXK-PM-CHN
Provider Second Line Business Practice Location Address:
BOX 105109
Provider Business Practice Location Address City Name:
FORT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-380-6027
Provider Business Practice Location Address Fax Number:
760-380-5861
Provider Enumeration Date:
04/04/2006