Provider First Line Business Practice Location Address:
1614 S MILDRED ST
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:
98465-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-534-3401
Provider Business Practice Location Address Fax Number:
253-564-9451
Provider Enumeration Date:
01/09/2007