Provider First Line Business Practice Location Address:
4707 S JUNETT ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409-6480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-475-8934
Provider Business Practice Location Address Fax Number:
253-472-0402
Provider Enumeration Date:
07/25/2006