Provider First Line Business Practice Location Address:
2215 N 30TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98403-3350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
235-572-3082
Provider Business Practice Location Address Fax Number:
253-572-3168
Provider Enumeration Date:
01/29/2007