Provider First Line Business Practice Location Address:
3209 S 23RD ST STE 340
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:
98405-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-682-2412
Provider Business Practice Location Address Fax Number:
253-682-2476
Provider Enumeration Date:
07/17/2009