Provider First Line Business Practice Location Address:
17TH AND C STREET
Provider Second Line Business Practice Location Address:
BLDG 11582
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-966-7647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2016