Provider First Line Business Practice Location Address:
1802 YAKIMA AVE STE 204
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:
98405-5304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-382-8540
Provider Business Practice Location Address Fax Number:
253-382-8545
Provider Enumeration Date:
04/18/2014