Organization
MAXIM
Active
Organization
MAXIM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADISON UMPHRES (INDIVIDUAL PROVIDER)
(520) 429-5502
Entity
Organization
Contact information
Practice address
4301 S PINE ST, SUITE 505, TACOMA, WA 98409-7264
(253) 292-4354
(855) 373-4004
Mailing address
4301 S PINE ST, SUITE 505, TACOMA, WA 98409-7264
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/26/2014
Last updated
06/26/2014
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