Provider First Line Business Practice Location Address:
717 TACOMA AVE S
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98402-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-627-4264
Provider Business Practice Location Address Fax Number:
253-779-0595
Provider Enumeration Date:
09/16/2008