Provider First Line Business Practice Location Address:
2368 YAKIMA AVE UNIT 613
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:
98405-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-677-5925
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2026