Provider First Line Business Practice Location Address:
1708 YAKIMA AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-5307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-5881
Provider Business Practice Location Address Fax Number:
253-383-0161
Provider Enumeration Date:
01/19/2007