Provider First Line Business Practice Location Address:
2522 S. PROCTOR ST.
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:
98406-5338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-389-3064
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2023