Provider First Line Business Practice Location Address:
1708 S YAKIMA AVE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-627-9151
Provider Business Practice Location Address Fax Number:
253-591-8892
Provider Enumeration Date:
05/11/2007