Provider First Line Business Practice Location Address:
3837 S 12TH 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:
98405-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-3501
Provider Business Practice Location Address Fax Number:
253-752-3504
Provider Enumeration Date:
01/08/2007