Provider First Line Business Practice Location Address:
1717 SOUTH 'J' STREET
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:
98401-2197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-426-6949
Provider Business Practice Location Address Fax Number:
253-426-6915
Provider Enumeration Date:
07/22/2009