Provider First Line Business Practice Location Address:
22 MEDICAL GROUP, 57950 LEAVENWORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCONNELL AFB
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67221-1772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-332-1838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2022