Provider First Line Business Practice Location Address:
1901 S UNION AVE BUILDING B
Provider Second Line Business Practice Location Address:
SUITE 6007
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-6780
Provider Business Practice Location Address Fax Number:
818-241-6853
Provider Enumeration Date:
04/12/2021