Provider First Line Business Practice Location Address:
3609 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:
98405-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-6056
Provider Business Practice Location Address Fax Number:
253-759-7129
Provider Enumeration Date:
08/01/2006