Provider First Line Business Practice Location Address:
LUKE AIR FORCE BASE
Provider Second Line Business Practice Location Address:
BLDG 317
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-856-7579
Provider Business Practice Location Address Fax Number:
623-856-4433
Provider Enumeration Date:
10/26/2006