Provider First Line Business Practice Location Address:
2210 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:
98403-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-3808
Provider Business Practice Location Address Fax Number:
253-272-9375
Provider Enumeration Date:
10/10/2006