Provider First Line Business Practice Location Address:
2520 N ALDER 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:
98406-6632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-6670
Provider Business Practice Location Address Fax Number:
253-572-9982
Provider Enumeration Date:
12/19/2006