Provider First Line Business Practice Location Address:
1708 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:
98405-5307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-858-4346
Provider Business Practice Location Address Fax Number:
253-858-4348
Provider Enumeration Date:
03/24/2010