Provider First Line Business Practice Location Address:
3502 S 12TH ST STE B
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:
98405-2279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-564-2220
Provider Business Practice Location Address Fax Number:
253-564-2221
Provider Enumeration Date:
08/30/2018