Provider First Line Business Practice Location Address:
1908 S YAKIMA AVE
Provider Second Line Business Practice Location Address:
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:
413-219-9455
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2026