Provider First Line Business Practice Location Address:
3906 S 74TH 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:
98409-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-833-9143
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2026