Provider First Line Business Practice Location Address:
701 HOSPITAL LOOP STE 321
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRCHILD AIR FORCE BASE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99011-8704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-247-2361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2016