Provider First Line Business Practice Location Address:
5917 N 26TH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98407-2359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-759-2299
Provider Business Practice Location Address Fax Number:
253-752-4930
Provider Enumeration Date:
05/15/2007