Provider First Line Business Practice Location Address:
314 M L KING WAY
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-383-3713
Provider Business Practice Location Address Fax Number:
253-383-0874
Provider Enumeration Date:
10/09/2013