Provider First Line Business Practice Location Address:
5615 VALLEY AVE E
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:
98424-2060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-922-6056
Provider Business Practice Location Address Fax Number:
253-922-3517
Provider Enumeration Date:
09/15/2006