Provider First Line Business Practice Location Address:
7901 S HOSMER ST
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:
98408-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-472-7488
Provider Business Practice Location Address Fax Number:
253-472-3789
Provider Enumeration Date:
06/13/2006