Provider First Line Business Practice Location Address:
8511 S TACOMA WAY STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-6521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-584-9164
Provider Business Practice Location Address Fax Number:
253-588-1722
Provider Enumeration Date:
12/02/2008