Provider First Line Business Practice Location Address:
2013 SO 19TH 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:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-383-3355
Provider Business Practice Location Address Fax Number:
253-383-3627
Provider Enumeration Date:
08/10/2006