Provider First Line Business Practice Location Address:
8717 S HOSMER 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:
98444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-473-7474
Provider Business Practice Location Address Fax Number:
253-474-9724
Provider Enumeration Date:
11/30/2006