Provider First Line Business Practice Location Address:
1717 SOUTH J STREET
Provider Second Line Business Practice Location Address:
MS 01-36
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-426-6341
Provider Business Practice Location Address Fax Number:
253-426-6344
Provider Enumeration Date:
06/22/2010