Provider First Line Business Practice Location Address:
1901 S CEDAR ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-1282
Provider Business Practice Location Address Fax Number:
253-572-1175
Provider Enumeration Date:
02/08/2007