Provider First Line Business Practice Location Address:
9503 19TH AVE E
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:
98445-5557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-471-2727
Provider Business Practice Location Address Fax Number:
253-471-2730
Provider Enumeration Date:
02/14/2007