Provider First Line Business Practice Location Address:
2115 S 56TH ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409-6902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-473-4303
Provider Business Practice Location Address Fax Number:
253-473-0201
Provider Enumeration Date:
01/22/2013