Provider First Line Business Practice Location Address:
MAMC 9040 REID ST
Provider Second Line Business Practice Location Address:
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:
03/21/2007