Provider First Line Business Practice Location Address:
5003 TACOMA MALL BLVD
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409-7120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-472-5813
Provider Business Practice Location Address Fax Number:
253-472-0640
Provider Enumeration Date:
08/16/2006