Provider First Line Business Practice Location Address:
3602 S 19TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-733-4372
Provider Business Practice Location Address Fax Number:
559-733-1758
Provider Enumeration Date:
07/04/2006