Provider First Line Business Practice Location Address:
1314 72ND ST E
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98404-3343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-531-5535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2014