Provider First Line Business Practice Location Address:
9040A JACKSON AVENUE, JOINT BASE LEWIS-MCCHORD 98341
Provider Second Line Business Practice Location Address:
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:
98341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-477-0822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2006