Provider First Line Business Practice Location Address:
2040 6TH AVE
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:
98403-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-1881
Provider Business Practice Location Address Fax Number:
253-572-5682
Provider Enumeration Date:
12/13/2006