Provider First Line Business Practice Location Address:
8904 S TACOMA WAY
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-4461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-983-1943
Provider Business Practice Location Address Fax Number:
253-983-9796
Provider Enumeration Date:
08/17/2007