Provider First Line Business Practice Location Address:
1317 134TH ST 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:
98444-2199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-433-7765
Provider Business Practice Location Address Fax Number:
253-503-0123
Provider Enumeration Date:
10/23/2025