Provider First Line Business Practice Location Address:
1720 S 72ND ST STE 201
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:
98408-1299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-471-1289
Provider Business Practice Location Address Fax Number:
253-471-1290
Provider Enumeration Date:
12/02/2009