Provider First Line Business Practice Location Address:
1212 S.11TH ST.
Provider Second Line Business Practice Location Address:
#47
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:
253-573-0070
Provider Business Practice Location Address Fax Number:
253-573-0272
Provider Enumeration Date:
12/01/2006