Provider First Line Business Practice Location Address:
1003 S 5TH ST STE 1P
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:
98405-4210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-403-6825
Provider Business Practice Location Address Fax Number:
253-864-2847
Provider Enumeration Date:
05/24/2006