Provider First Line Business Practice Location Address:
VA PUGET SOUND HCS - AMERICAN LAKE
Provider Second Line Business Practice Location Address:
A-116-M
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-583-1774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2006