Provider First Line Business Practice Location Address:
9900 LINCOLN STREET, 2ND FLOOR
Provider Second Line Business Practice Location Address:
ATTN: CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-4079
Provider Business Practice Location Address Fax Number:
253-968-5916
Provider Enumeration Date:
08/19/2015