Provider First Line Business Practice Location Address:
2913 S 38TH ST STE B3
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:
98409-5629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-473-1050
Provider Business Practice Location Address Fax Number:
253-473-2338
Provider Enumeration Date:
07/25/2006