Provider First Line Business Practice Location Address:
1802 YAKIMA AVE STE 103
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:
98405-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-1077
Provider Business Practice Location Address Fax Number:
253-627-8792
Provider Enumeration Date:
08/29/2006