Provider First Line Business Practice Location Address:
8208 14TH AVE E
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:
98404-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-407-9889
Provider Business Practice Location Address Fax Number:
253-264-1696
Provider Enumeration Date:
06/15/2026