Provider First Line Business Practice Location Address:
5218 S PUGET SOUND AVE
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:
98409-4317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-861-8200
Provider Business Practice Location Address Fax Number:
253-473-2806
Provider Enumeration Date:
09/29/2011