Provider First Line Business Practice Location Address:
860 SOUTH 54TH 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:
98408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-207-8816
Provider Business Practice Location Address Fax Number:
253-472-0672
Provider Enumeration Date:
12/20/2006