Provider First Line Business Practice Location Address:
2302 S UNION AVE
Provider Second Line Business Practice Location Address:
BUILDING B SUITE 12
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:
253-752-2447
Provider Business Practice Location Address Fax Number:
253-752-2448
Provider Enumeration Date:
11/09/2006