Provider First Line Business Practice Location Address:
5280 PENDLETON AVE STE C0006
Provider Second Line Business Practice Location Address:
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:
98433-1672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-964-4140
Provider Business Practice Location Address Fax Number:
253-964-1696
Provider Enumeration Date:
07/17/2009