Provider First Line Business Practice Location Address:
130 131ST ST S
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:
98444-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-539-7445
Provider Business Practice Location Address Fax Number:
253-539-7538
Provider Enumeration Date:
04/10/2007