Provider First Line Business Practice Location Address:
1401 S UNION AVE
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:
98405-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-396-0032
Provider Business Practice Location Address Fax Number:
253-396-0034
Provider Enumeration Date:
06/19/2006