Provider First Line Business Practice Location Address:
1702 S 72ND ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98408-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-460-4848
Provider Business Practice Location Address Fax Number:
253-460-4949
Provider Enumeration Date:
04/16/2010