Provider First Line Business Practice Location Address:
2811 S 12TH 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:
98405-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-495-7010
Provider Business Practice Location Address Fax Number:
253-858-6806
Provider Enumeration Date:
02/26/2008