Provider First Line Business Practice Location Address:
1211 S TRAFTON 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:
98405-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-267-1044
Provider Business Practice Location Address Fax Number:
253-267-1056
Provider Enumeration Date:
01/31/2023