Provider First Line Business Practice Location Address:
205 N 1ST ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
YELM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-458-0905
Provider Business Practice Location Address Fax Number:
360-458-0910
Provider Enumeration Date:
12/23/2009