Provider First Line Business Practice Location Address:
101 W SPAATZ RD
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:
99011-9447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-244-9729
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2012