Provider First Line Business Practice Location Address:
COLUMBUS AFB 201 INDEPENDENCE DR
Provider Second Line Business Practice Location Address:
14TH MEDICAL GROUP
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39710-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-434-1126
Provider Business Practice Location Address Fax Number:
662-434-2246
Provider Enumeration Date:
03/16/2009