Provider First Line Business Practice Location Address:
1901 S CEDAR ST
Provider Second Line Business Practice Location Address:
STE. B-1
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:
253-272-6910
Provider Business Practice Location Address Fax Number:
253-383-4218
Provider Enumeration Date:
04/10/2006