Provider First Line Business Practice Location Address:
1802 YAKIMA AVE
Provider Second Line Business Practice Location Address:
SUITE 102A
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-4499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-426-4146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007