Provider First Line Business Practice Location Address:
BLDG 2008B 3RD AVENUE N
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:
98431-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-967-1445
Provider Business Practice Location Address Fax Number:
253-967-1411
Provider Enumeration Date:
02/17/2011