Provider First Line Business Practice Location Address:
1516 S 11TH 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:
98405-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-396-1634
Provider Business Practice Location Address Fax Number:
253-396-1663
Provider Enumeration Date:
11/20/2008