Provider First Line Business Practice Location Address:
3716 PACIFIC AVE
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98418-7836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-474-5715
Provider Business Practice Location Address Fax Number:
253-473-5309
Provider Enumeration Date:
08/21/2006