Provider First Line Business Practice Location Address:
4707 S 19TH ST STE 210
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:
98405-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-3331
Provider Business Practice Location Address Fax Number:
253-752-3338
Provider Enumeration Date:
12/27/2006