Provider First Line Business Practice Location Address:
BLDG 2460
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-247-2507
Provider Business Practice Location Address Fax Number:
509-247-5594
Provider Enumeration Date:
09/22/2006