Provider First Line Business Practice Location Address:
1622 S MILDRED ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98465-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-588-2721
Provider Business Practice Location Address Fax Number:
253-984-9366
Provider Enumeration Date:
06/16/2010