Provider First Line Business Practice Location Address:
4505 S 19TH 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:
98405-1183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-9110
Provider Business Practice Location Address Fax Number:
253-756-9320
Provider Enumeration Date:
12/13/2013