Provider First Line Business Practice Location Address:
482D MEDICAL SQUADRON
Provider Second Line Business Practice Location Address:
12749 ELMENDORF ST BLDG 347
Provider Business Practice Location Address City Name:
HOMESTEAD AFB
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33039-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-415-7615
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2015