Provider First Line Business Practice Location Address:
715 YELM AVENUE WEST
Provider Second Line Business Practice Location Address:
SUITE # 5
Provider Business Practice Location Address City Name:
YELM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-458-2225
Provider Business Practice Location Address Fax Number:
360-458-3663
Provider Enumeration Date:
01/22/2007