Provider First Line Business Practice Location Address:
1115 TACOMA AVE 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:
98402-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-533-0726
Provider Business Practice Location Address Fax Number:
206-397-0958
Provider Enumeration Date:
09/16/2026