Provider First Line Business Practice Location Address:
1901 S UNION
Provider Second Line Business Practice Location Address:
SUITE B5001
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-6402
Provider Business Practice Location Address Fax Number:
253-572-9590
Provider Enumeration Date:
12/12/2006