Provider First Line Business Practice Location Address:
7247 S PINE ST STE A
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:
98409-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-473-7518
Provider Business Practice Location Address Fax Number:
253-474-9596
Provider Enumeration Date:
01/10/2007