Provider First Line Business Practice Location Address:
JOINT BASE LEWIS MCCHORD
Provider Second Line Business Practice Location Address:
9040A JACKSON AVE
Provider Business Practice Location Address City Name:
TACOMA
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:
350-742-2196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2010