Provider First Line Business Practice Location Address:
223 140TH ST S STE 500
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:
98444-4548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-561-9147
Provider Business Practice Location Address Fax Number:
253-535-4888
Provider Enumeration Date:
08/25/2005