Provider First Line Business Practice Location Address:
701 HOSPITAL LOOP
Provider Second Line Business Practice Location Address:
92 AMDS/SGPE
Provider Business Practice Location Address City Name:
FAIRCHILD AFB
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99011-8704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-247-5755
Provider Business Practice Location Address Fax Number:
507-247-8833
Provider Enumeration Date:
05/11/2009