Provider First Line Business Practice Location Address:
3318 BRIDGEPORT WAY W
Provider Second Line Business Practice Location Address:
SUITE D3
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-564-4450
Provider Business Practice Location Address Fax Number:
253-444-0543
Provider Enumeration Date:
01/13/2011