Provider First Line Business Practice Location Address:
223 140TH STREET SOUTH
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-537-1559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2012