Provider First Line Business Practice Location Address:
VA PSHCS AMERICAN LAKE DIVISION DENTAL SERVICE
Provider Second Line Business Practice Location Address:
MAIL STOP: A-112-DENT
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-589-4005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006