Provider First Line Business Practice Location Address:
1901 S 72ND ST
Provider Second Line Business Practice Location Address:
SUITE A-14
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98408-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-473-4394
Provider Business Practice Location Address Fax Number:
253-471-0743
Provider Enumeration Date:
04/20/2007