Provider First Line Business Practice Location Address:
1550 S UNION AVE
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-0714
Provider Business Practice Location Address Fax Number:
253-761-2451
Provider Enumeration Date:
12/29/2006