Provider First Line Business Practice Location Address:
9600 VETERANS DR SOUTHWEST (PART-TIME)
Provider Second Line Business Practice Location Address:
BUILDING 6 RM 134A
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493-0003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-267-1985
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2006