Provider First Line Business Practice Location Address:
CREDENTENTIALS OFFICE MADIGAN ARMY MEDICAL CTR
Provider Second Line Business Practice Location Address:
9040 FITZSIMONS DRIVE, ATTN: MCHJ-CI
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:
253-968-1160
Provider Business Practice Location Address Fax Number:
253-399-2882
Provider Enumeration Date:
04/19/2006