Provider First Line Business Practice Location Address:
VA PUGET SOUND AMER LAKE DV # A112
Provider Second Line Business Practice Location Address:
9600 VETERANS DRIVE, BLDG. 85
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:
253-589-4005
Provider Business Practice Location Address Fax Number:
253-589-4162
Provider Enumeration Date:
09/06/2006