Provider First Line Business Practice Location Address:
1112 S CUSHMAN AVE
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:
98405-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-593-2144
Provider Business Practice Location Address Fax Number:
253-346-6725
Provider Enumeration Date:
12/05/2023