Provider First Line Business Practice Location Address:
2201 SOUTH 19TH STREET
Provider Second Line Business Practice Location Address:
STE #101
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
255-475-5433
Provider Business Practice Location Address Fax Number:
253-473-6715
Provider Enumeration Date:
04/18/2006