Provider First Line Business Practice Location Address:
1529 N PROSPECT 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:
98406-8107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-282-5298
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2010