Provider First Line Business Practice Location Address:
6040 20TH ST E
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:
98424-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-922-2266
Provider Business Practice Location Address Fax Number:
253-926-3566
Provider Enumeration Date:
01/14/2008