Provider First Line Business Practice Location Address:
BLDG 9900, 2D FLOOR
Provider Second Line Business Practice Location Address:
HQS, USA DENTAC, FT LEWIS
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-4039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2006