Provider First Line Business Practice Location Address:
9040 JACKSON AVE
Provider Second Line Business Practice Location Address:
MADIGAN ARMY MEDICAL CENTER, ATTN: MCHJ-CLG-M
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-2417
Provider Business Practice Location Address Fax Number:
253-968-1254
Provider Enumeration Date:
04/23/2008