Provider First Line Business Practice Location Address:
2126 N ORCHARD 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:
98406-3454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-1951
Provider Business Practice Location Address Fax Number:
253-752-1951
Provider Enumeration Date:
05/11/2026