Provider First Line Business Practice Location Address:
22ND MEDICAL GROUP
Provider Second Line Business Practice Location Address:
57950 LEAVENWORTH STREET
Provider Business Practice Location Address City Name:
MCCONNELL AIR FORCE BASE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67221-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-759-2029
Provider Business Practice Location Address Fax Number:
316-759-6277
Provider Enumeration Date:
11/12/2007