Provider First Line Business Practice Location Address:
BLDG 2202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT LEWIS
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:
253-966-1106
Provider Business Practice Location Address Fax Number:
253-968-3349
Provider Enumeration Date:
09/22/2006