Provider First Line Business Practice Location Address:
1307 S 11TH 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:
98405-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-274-9732
Provider Business Practice Location Address Fax Number:
253-274-9736
Provider Enumeration Date:
06/14/2006