Provider First Line Business Practice Location Address:
MADIGAN ANNEX, E JOHNSON ST
Provider Second Line Business Practice Location Address:
BUILDING 9911C, RAMP 2
Provider Business Practice Location Address City Name:
JOINT BASE LEWIS-MCCHORD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-3431
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2022