Provider First Line Business Practice Location Address:
1201 N FERDINAND ST
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:
98406-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-324-8793
Provider Business Practice Location Address Fax Number:
253-356-6132
Provider Enumeration Date:
05/24/2007