Provider First Line Business Practice Location Address:
JOINT BASE LEWIS MCCHORD DENTAC
Provider Second Line Business Practice Location Address:
BLDG. 9900, 2ND FLOOR, LINCOLN STREET
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-4029
Provider Business Practice Location Address Fax Number:
253-968-5919
Provider Enumeration Date:
06/27/2011