Provider First Line Business Practice Location Address:
311 MARTIN LUTHER KING JR. WAY
Provider Second Line Business Practice Location Address:
MS:315-C2-PHP
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:
253-403-1418
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2019