Provider First Line Business Practice Location Address:
722 MARTIN LUTHER KING AVE.
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:
98403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-548-4015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007