Provider First Line Business Practice Location Address:
BUILDING 9920B EAST HAYES ST.
Provider Second Line Business Practice Location Address:
MADIGAN AMC, ATTN: MCHJ-PV
Provider Business Practice Location Address City Name:
TACOMA
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:
253-968-4482
Provider Business Practice Location Address Fax Number:
253-968-4483
Provider Enumeration Date:
03/14/2006