Provider First Line Business Practice Location Address:
1112 6TH AVE, MAILSTOP 1112-3-TFM
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-792-6680
Provider Business Practice Location Address Fax Number:
253-403-2915
Provider Enumeration Date:
03/30/2026