Provider First Line Business Practice Location Address:
16534 45TH AVE E STE B
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:
98446-4533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-867-6345
Provider Business Practice Location Address Fax Number:
800-394-4581
Provider Enumeration Date:
04/21/2026