Provider First Line Business Practice Location Address:
3716 PACIFIC AVE
Provider Second Line Business Practice Location Address:
SUITE B
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:
253-472-9850
Provider Business Practice Location Address Fax Number:
253-472-6479
Provider Enumeration Date:
11/15/2006