Provider First Line Business Practice Location Address:
BLDG 2006A /LIGGET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LEWIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-967-1447
Provider Business Practice Location Address Fax Number:
253-967-1199
Provider Enumeration Date:
03/15/2006