Provider First Line Business Practice Location Address:
2504 S CHICAGO ST
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:
99011-8548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-247-5414
Provider Business Practice Location Address Fax Number:
509-247-3543
Provider Enumeration Date:
04/23/2009