Provider First Line Business Practice Location Address:
2102 N 30TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98403-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-383-0101
Provider Business Practice Location Address Fax Number:
253-383-0149
Provider Enumeration Date:
02/02/2007