Provider First Line Business Practice Location Address:
2006 A LIGGIT AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. LEWIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-967-1442
Provider Business Practice Location Address Fax Number:
253-967-1411
Provider Enumeration Date:
02/28/2006