Provider First Line Business Practice Location Address:
2312 N 30TH ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-396-9001
Provider Business Practice Location Address Fax Number:
253-396-1231
Provider Enumeration Date:
01/24/2006