Provider First Line Business Practice Location Address:
1902 S CEDAR ST
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:
98405-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-761-9255
Provider Business Practice Location Address Fax Number:
253-752-7829
Provider Enumeration Date:
12/30/2008