Provider First Line Business Practice Location Address:
2914 S ALDER 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:
98409-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-9245
Provider Business Practice Location Address Fax Number:
253-272-9413
Provider Enumeration Date:
11/09/2006