Provider First Line Business Practice Location Address:
AMERICAN LAKE VA - 9600 VETERANS DRIVE S
Provider Second Line Business Practice Location Address:
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:
253-583-2839
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2015