Provider First Line Business Practice Location Address:
205 117TH ST S
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:
98444-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-531-7111
Provider Business Practice Location Address Fax Number:
253-531-7112
Provider Enumeration Date:
01/17/2007