Provider First Line Business Practice Location Address:
9119 MIL PARK AVE
Provider Second Line Business Practice Location Address:
BLDG 9119
Provider Business Practice Location Address City Name:
JOINT BASE LEWIS-MCCHORD
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:
253-477-0803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2013