Provider First Line Business Practice Location Address:
1310 S UNION AVE
Provider Second Line Business Practice Location Address:
SUITE B-1
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-9923
Provider Business Practice Location Address Fax Number:
253-572-8224
Provider Enumeration Date:
09/25/2006