Provider First Line Business Practice Location Address:
9040 REID ST
Provider Second Line Business Practice Location Address:
ATTN: MCHJ-CLQ-C
Provider Business Practice Location Address City Name:
JOINT BASE LEWIS MCCHORD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-1110
Provider Business Practice Location Address Fax Number:
877-874-1031
Provider Enumeration Date:
03/29/2016