Provider First Line Business Practice Location Address:
USA MEDDAC-WACH
Provider Second Line Business Practice Location Address:
4TH & INNER LOOP
Provider Business Practice Location Address City Name:
FORT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-380-6566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2007