Provider First Line Business Practice Location Address:
1708 E. 44TH STREET
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:
98404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-471-4553
Provider Business Practice Location Address Fax Number:
253-474-5395
Provider Enumeration Date:
07/15/2006