Provider First Line Business Practice Location Address:
12202 PACIFIC AVE S STE A
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:
98444-5157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-523-2821
Provider Business Practice Location Address Fax Number:
360-838-6543
Provider Enumeration Date:
12/22/2025