Provider First Line Business Practice Location Address:
1112 6TH AVE STE 100
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:
98405-4048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-3916
Provider Business Practice Location Address Fax Number:
253-274-1685
Provider Enumeration Date:
06/30/2008