Provider First Line Business Practice Location Address:
4707 S 19TH ST LOWR LEVEL
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:
98405-1157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-442-2234
Provider Business Practice Location Address Fax Number:
253-752-8800
Provider Enumeration Date:
06/27/2006