Provider First Line Business Practice Location Address:
5225 TACOMA MALL BLVD
Provider Second Line Business Practice Location Address:
SUITE E-104
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409-7018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-474-3223
Provider Business Practice Location Address Fax Number:
253-473-6762
Provider Enumeration Date:
09/17/2012