Provider First Line Business Practice Location Address:
2520 S 38TH ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-343-9133
Provider Business Practice Location Address Fax Number:
253-343-9135
Provider Enumeration Date:
01/18/2007