Provider First Line Business Practice Location Address:
8833 PACIFIC AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98444-6490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-531-1000
Provider Business Practice Location Address Fax Number:
253-531-0967
Provider Enumeration Date:
04/09/2007