Provider First Line Business Practice Location Address:
4001 CAPITOL MALL DRIVE SW
Provider Second Line Business Practice Location Address:
PUGET SOUND HEALTHCARE CENTER
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-357-7677
Provider Business Practice Location Address Fax Number:
360-754-0627
Provider Enumeration Date:
07/13/2007