Provider First Line Business Practice Location Address:
2522 N PROCTOR ST
Provider Second Line Business Practice Location Address:
468
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98406-5338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-376-7605
Provider Business Practice Location Address Fax Number:
253-276-1792
Provider Enumeration Date:
12/06/2010