Provider First Line Business Practice Location Address:
1818 S UNION AVE
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-759-2700
Provider Business Practice Location Address Fax Number:
253-759-9986
Provider Enumeration Date:
05/10/2012