Provider First Line Business Practice Location Address:
609 144TH 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:
98444-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-441-9065
Provider Business Practice Location Address Fax Number:
206-299-0751
Provider Enumeration Date:
04/17/2026