Provider First Line Business Practice Location Address:
2008 B NORTH 3RD ST
Provider Second Line Business Practice Location Address:
RM 313
Provider Business Practice Location Address City Name:
JOINT BASE LEWIS MCCORD
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:
253-967-1410
Provider Business Practice Location Address Fax Number:
253-967-1411
Provider Enumeration Date:
09/27/2006