Provider First Line Business Practice Location Address:
9933C W HAYES ST
Provider Second Line Business Practice Location Address:
OMAMC, BLDG 9933C
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:
206-697-0115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2008