Provider First Line Business Practice Location Address:
1550 SOUTH UNION AVENUE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-4601
Provider Business Practice Location Address Fax Number:
253-572-4769
Provider Enumeration Date:
04/22/2006