Provider First Line Business Practice Location Address:
1901 S UNION AVE
Provider Second Line Business Practice Location Address:
SUITE B 7011
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-627-7012
Provider Business Practice Location Address Fax Number:
253-627-7014
Provider Enumeration Date:
11/20/2006