Provider First Line Business Practice Location Address:
2312 N 30TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98403-3356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-927-4040
Provider Business Practice Location Address Fax Number:
253-404-0687
Provider Enumeration Date:
08/21/2007