Provider First Line Business Practice Location Address:
20B N TACOMA AVE
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:
98403-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-404-0501
Provider Business Practice Location Address Fax Number:
253-272-2188
Provider Enumeration Date:
12/21/2006