Provider First Line Business Practice Location Address:
1310 SOUTH UNION
Provider Second Line Business Practice Location Address:
A-201
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-3149
Provider Business Practice Location Address Fax Number:
253-272-3348
Provider Enumeration Date:
02/14/2008