Provider First Line Business Practice Location Address:
158 138TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-531-3414
Provider Business Practice Location Address Fax Number:
253-539-1272
Provider Enumeration Date:
11/16/2006