Provider First Line Business Practice Location Address:
4020 S 56TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-380-7736
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2007