Provider First Line Business Practice Location Address:
1819 E 72ND 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:
98404-5406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-222-8486
Provider Business Practice Location Address Fax Number:
253-864-4997
Provider Enumeration Date:
03/16/2009