Provider First Line Business Practice Location Address:
1512 112TH 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:
98444-2556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-468-5259
Provider Business Practice Location Address Fax Number:
253-267-1025
Provider Enumeration Date:
03/31/2026