Provider First Line Business Practice Location Address:
92D MEDICAL GROUP/SGOW
Provider Second Line Business Practice Location Address:
701 HOSPITAL LOOP, SUITE 259
Provider Business Practice Location Address City Name:
FAIRCHILD AFB
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-247-5409
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2019