Provider First Line Business Practice Location Address:
10909 PORTLAND AVE E
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98445-5252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-970-0433
Provider Business Practice Location Address Fax Number:
253-535-1349
Provider Enumeration Date:
05/17/2012