Provider First Line Business Practice Location Address:
130 131ST STREET SOUTH
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-539-7445
Provider Business Practice Location Address Fax Number:
253-539-7538
Provider Enumeration Date:
08/06/2014