Provider First Line Business Practice Location Address:
1514 S ADAMS 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:
98405-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-678-1212
Provider Business Practice Location Address Fax Number:
253-581-2444
Provider Enumeration Date:
05/16/2007