Provider First Line Business Practice Location Address:
4424 6TH AVE., #1G
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-4557
Provider Business Practice Location Address Fax Number:
253-272-0748
Provider Enumeration Date:
02/07/2007