Provider First Line Business Practice Location Address:
615 N PROCTOR 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:
98406-4931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-292-5812
Provider Business Practice Location Address Fax Number:
253-617-7768
Provider Enumeration Date:
08/29/2022