Provider First Line Business Practice Location Address:
20 N TACOMA AVE 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:
98403-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-232-8722
Provider Business Practice Location Address Fax Number:
253-627-1753
Provider Enumeration Date:
12/05/2007