Provider First Line Business Practice Location Address:
3704 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:
98418-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-671-4407
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2009