Provider First Line Business Practice Location Address:
3320 S 23RD ST
Provider Second Line Business Practice Location Address:
T0341
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-627-2112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2011