Provider First Line Business Practice Location Address:
690 BARNES BLVD
Provider Second Line Business Practice Location Address:
ATTN: SGHC
Provider Business Practice Location Address City Name:
MCCHORD AFB
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-982-9918
Provider Business Practice Location Address Fax Number:
253-982-0283
Provider Enumeration Date:
06/08/2006