Provider First Line Business Practice Location Address:
2106 147TH STREET CT 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:
98445-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-632-3915
Provider Business Practice Location Address Fax Number:
253-294-7337
Provider Enumeration Date:
04/30/2025