Provider First Line Business Practice Location Address:
9312 S TACOMA WAY STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-4474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-251-2551
Provider Business Practice Location Address Fax Number:
253-251-3197
Provider Enumeration Date:
09/12/2005