Provider First Line Business Practice Location Address:
8001 S HOSMER ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98408-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-302-4178
Provider Business Practice Location Address Fax Number:
253-503-0858
Provider Enumeration Date:
10/18/2005