Provider First Line Business Practice Location Address:
2302 S UNION AVE
Provider Second Line Business Practice Location Address:
SUITE A-2
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-5933
Provider Business Practice Location Address Fax Number:
253-752-6535
Provider Enumeration Date:
10/18/2006