Provider First Line Business Practice Location Address:
9104 S TACOMA WAY STE 106F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-314-5742
Provider Business Practice Location Address Fax Number:
253-314-5718
Provider Enumeration Date:
04/14/2011