Provider First Line Business Practice Location Address:
4538 S PINE 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:
98409-6527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-474-4404
Provider Business Practice Location Address Fax Number:
253-474-7555
Provider Enumeration Date:
09/20/2006