Provider First Line Business Practice Location Address:
1215 S UNION AVE
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:
98405-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-3066
Provider Business Practice Location Address Fax Number:
253-759-9816
Provider Enumeration Date:
09/15/2005