Provider First Line Business Practice Location Address:
5006 CENTER ST STE U
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:
98409-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-284-4488
Provider Business Practice Location Address Fax Number:
253-272-4771
Provider Enumeration Date:
06/16/2005