Provider First Line Business Practice Location Address: 
315 MARTIN LUTHER KING JR WAY
    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: 
98405-4234
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
253-403-1000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/11/2009