Provider First Line Business Practice Location Address:
5702 N 26TH ST STE B
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:
98407-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
243-752-3484
Provider Business Practice Location Address Fax Number:
253-752-2930
Provider Enumeration Date:
04/17/2007