Provider First Line Business Practice Location Address:
223 N K ST
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:
98403-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-4115
Provider Business Practice Location Address Fax Number:
253-572-7446
Provider Enumeration Date:
11/03/2006