Provider First Line Business Practice Location Address:
9600 VETERANS DRIVE AMERICAN LAKE DIVISION
Provider Second Line Business Practice Location Address:
BUILDING 148, ROOM 113
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-583-1615
Provider Business Practice Location Address Fax Number:
253-583-4042
Provider Enumeration Date:
03/28/2008