Provider First Line Business Practice Location Address:
13412 PACIFIC AVE S
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:
98444-4866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-531-5242
Provider Business Practice Location Address Fax Number:
253-537-7293
Provider Enumeration Date:
08/15/2007