Provider First Line Business Practice Location Address:
5702 N 26TH ST STE B
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:
98407-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-292-1216
Provider Business Practice Location Address Fax Number:
253-265-4950
Provider Enumeration Date:
05/15/2007