Provider First Line Business Practice Location Address:
3401 S 19TH ST
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:
98405-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-573-1600
Provider Business Practice Location Address Fax Number:
253-573-1601
Provider Enumeration Date:
06/07/2007