Provider First Line Business Practice Location Address:
1520 N PROSPECT 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:
98406-8108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-8468
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2011