Provider First Line Business Practice Location Address:
1112 6TH AVE STE 101
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:
98405-4048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-0180
Provider Business Practice Location Address Fax Number:
253-561-0018
Provider Enumeration Date:
11/19/2009