Provider First Line Business Practice Location Address:
BUILDING 11582
Provider Second Line Business Practice Location Address:
17TH & C STREET
Provider Business Practice Location Address City Name:
JOINT BASE LEWIS-MCCHORD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-966-7633
Provider Business Practice Location Address Fax Number:
253-967-2639
Provider Enumeration Date:
04/23/2019