Provider First Line Business Practice Location Address:
BUILDING 13815 CORNER F & 8TH ST
Provider Second Line Business Practice Location Address:
SCMH1 555EN/ 17 FAB
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-4888
Provider Business Practice Location Address Fax Number:
253-477-2906
Provider Enumeration Date:
04/05/2016