Provider First Line Business Practice Location Address:
3333 N WHITMAN ST
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:
98407-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-759-3065
Provider Business Practice Location Address Fax Number:
253-759-3075
Provider Enumeration Date:
01/24/2008