Provider First Line Business Practice Location Address:
3602 S 19TH STREET
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:
98405-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-759-5555
Provider Business Practice Location Address Fax Number:
253-830-5420
Provider Enumeration Date:
07/07/2006