Provider First Line Business Practice Location Address:
2302 SO. UNION AVE.
Provider Second Line Business Practice Location Address:
SUITE C-22
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-6336
Provider Business Practice Location Address Fax Number:
253-752-5655
Provider Enumeration Date:
04/03/2007