Provider First Line Business Practice Location Address:
9601 S TACOMA WATY
Provider Second Line Business Practice Location Address:
SUITE 105-106
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-581-3426
Provider Business Practice Location Address Fax Number:
253-581-3428
Provider Enumeration Date:
09/27/2013