Provider First Line Business Practice Location Address:
5038 TACOMA MALL BLVD
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-473-2166
Provider Business Practice Location Address Fax Number:
253-473-2167
Provider Enumeration Date:
01/25/2006