Provider First Line Business Practice Location Address:
9900 VETERANS DR SW
Provider Second Line Business Practice Location Address:
VA PSHCS AL RCS 117
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-583-1812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2006