Provider First Line Business Practice Location Address:
9601 STEILACOOM BLVD SW
Provider Second Line Business Practice Location Address:
WESTERN STATE HOSPITAL
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-961-7582
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2007