Provider First Line Business Practice Location Address:
4050 S 19TH ST STE 202
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:
98405-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-565-3355
Provider Business Practice Location Address Fax Number:
253-564-6744
Provider Enumeration Date:
08/02/2006