Provider First Line Business Practice Location Address:
1101 N 12TH ST
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98403-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-468-4210
Provider Business Practice Location Address Fax Number:
253-627-3433
Provider Enumeration Date:
08/13/2007