Provider First Line Business Practice Location Address:
1900 COMMERCE ST
Provider Second Line Business Practice Location Address:
MDS110
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98402-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-692-4758
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2012