Provider First Line Business Practice Location Address:
316 MLK JR WAY
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-383-5777
Provider Business Practice Location Address Fax Number:
253-383-7136
Provider Enumeration Date:
04/02/2009