Provider First Line Business Practice Location Address:
314 MLK JR. WAY
Provider Second Line Business Practice Location Address:
SUITE 300
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:
253-274-1668
Provider Business Practice Location Address Fax Number:
253-274-1685
Provider Enumeration Date:
05/17/2011