Provider First Line Business Practice Location Address:
12002 PACIFIC AVE
Provider Second Line Business Practice Location Address:
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:
253-531-5700
Provider Business Practice Location Address Fax Number:
253-535-4503
Provider Enumeration Date:
02/23/2007