Provider First Line Business Practice Location Address:
709 HOSPITAL LOOP STE 118
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRCHILD AFB
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99011-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-465-0995
Provider Business Practice Location Address Fax Number:
509-247-4140
Provider Enumeration Date:
05/24/2005