Provider First Line Business Practice Location Address:
BLDG 11582 17TH AND C ST
Provider Second Line Business Practice Location Address:
MADIGAN ARMY MEDICAL CTR
Provider Business Practice Location Address City Name:
NORR FORT LEWIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-966-7623
Provider Business Practice Location Address Fax Number:
253-968-3349
Provider Enumeration Date:
09/22/2006