Provider First Line Business Practice Location Address:
707 S 56TH 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:
98408-5617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-471-1730
Provider Business Practice Location Address Fax Number:
253-471-3529
Provider Enumeration Date:
06/21/2006