Provider First Line Business Practice Location Address:
1708 SOUTH YAKIMA
Provider Second Line Business Practice Location Address:
SUITE 201 CENTURY PLAZA PHARMACY
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-426-4205
Provider Business Practice Location Address Fax Number:
253-426-6420
Provider Enumeration Date:
03/12/2007