Provider First Line Business Practice Location Address:
1742 MARKET ST
Provider Second Line Business Practice Location Address:
STE. 102
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98402-3223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-692-5811
Provider Business Practice Location Address Fax Number:
253-692-4768
Provider Enumeration Date:
10/19/2007