Provider First Line Business Practice Location Address:
4002 SOUTH 'M' STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-474-0606
Provider Business Practice Location Address Fax Number:
253-476-3901
Provider Enumeration Date:
08/04/2006