Provider First Line Business Practice Location Address:
2136 MARTIN LUTHER KING JR WAY
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:
98405-3838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-285-0821
Provider Business Practice Location Address Fax Number:
206-659-7691
Provider Enumeration Date:
08/08/2024