Organization
UNITED STATES PUBLIC HEALTH SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONHNNY BROUSSARD (HEALTH SERVICE ADMINITRATOR)
(253) 779-6052
Entity
Organization
Contact information
Practice address
1623 E J ST, TACOMA, WA 98421-1602
(253) 552-4947
(253) 779-6005
Mailing address
1623 E J ST, TACOMA, WA 98421-1602
(253) 552-4947
(253) 779-6005
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
AP30005661
WA
Other
Enumeration date
12/07/2011
Last updated
12/07/2011
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