Provider First Line Business Practice Location Address:
DEPT OF VETERANS AFFAIRS
Provider Second Line Business Practice Location Address:
AMERICAN LAKE DIVISION A-123 RED
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-583-1234
Provider Business Practice Location Address Fax Number:
253-589-4150
Provider Enumeration Date:
08/20/2009