Provider First Line Business Practice Location Address:
PSHCS AMERICAN LAKE DIVISION
Provider Second Line Business Practice Location Address:
A-111-PC
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-582-8440
Provider Business Practice Location Address Fax Number:
253-589-4150
Provider Enumeration Date:
07/22/2006