Provider First Line Business Practice Location Address:
8002 PORTLAND AVE E
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:
98404-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-472-5272
Provider Business Practice Location Address Fax Number:
253-472-5272
Provider Enumeration Date:
11/17/2006