Provider First Line Business Practice Location Address:
2208 N 30TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98403-3351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-383-5636
Provider Business Practice Location Address Fax Number:
253-274-0604
Provider Enumeration Date:
07/27/2006