Provider First Line Business Practice Location Address: 
MADIGAN ARMY MEDICAL CENTER
    Provider Second Line Business Practice Location Address: 
9040 REID ST., ATTN: MCHJ-QCR
    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: 
253-968-2252
    Provider Business Practice Location Address Fax Number: 
253-968-3278
    Provider Enumeration Date: 
02/28/2006