Provider First Line Business Practice Location Address:
6623 50TH 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:
98443-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-993-8597
Provider Business Practice Location Address Fax Number:
253-993-8597
Provider Enumeration Date:
10/25/2012