Provider First Line Business Practice Location Address:
1311 SOUTH UNION AVENUE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-759-0404
Provider Business Practice Location Address Fax Number:
253-759-0147
Provider Enumeration Date:
12/05/2006