Provider First Line Business Practice Location Address:
9040A JACKSON AVE
Provider Second Line Business Practice Location Address:
MADIGAN ARMY MEDICAL CENTER
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-9500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-1574
Provider Business Practice Location Address Fax Number:
253-968-3148
Provider Enumeration Date:
10/12/2007