Provider First Line Business Practice Location Address:
MAMC 9040 JACKSON AVE
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:
98431-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-477-0968
Provider Business Practice Location Address Fax Number:
253-477-0818
Provider Enumeration Date:
08/29/2006