Provider First Line Business Practice Location Address:
A-112-BRC BLIND REHABILITATION CTR
Provider Second Line Business Practice Location Address:
AMERICAN LAKE/VAMC
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-582-8440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2006