Provider First Line Business Practice Location Address:
3102 S 23RD ST
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:
98405-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-355-6619
Provider Business Practice Location Address Fax Number:
213-285-6558
Provider Enumeration Date:
01/18/2012