Provider First Line Business Practice Location Address:
USA MEDDAC, RWBAHC
Provider Second Line Business Practice Location Address:
2240 E. WINROW AVE., ATTN: MCXJ-CREDENTIALS
Provider Business Practice Location Address City Name:
FORT HUACHUCA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85613-7079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-599-1696
Provider Business Practice Location Address Fax Number:
520-533-7099
Provider Enumeration Date:
10/19/2006