Provider First Line Business Practice Location Address:
1924A S CEDAR 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:
98405-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-627-9145
Provider Business Practice Location Address Fax Number:
253-383-1556
Provider Enumeration Date:
12/14/2005