Provider First Line Business Practice Location Address:
1105 N OAKES 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:
98406-7319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-1153
Provider Business Practice Location Address Fax Number:
253-759-9399
Provider Enumeration Date:
04/06/2007