Provider First Line Business Practice Location Address:
3720 6TH AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98406-4938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-1320
Provider Business Practice Location Address Fax Number:
253-752-1425
Provider Enumeration Date:
02/04/2010