Provider First Line Business Practice Location Address:
1314 8TH ST NE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-4587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-804-2788
Provider Business Practice Location Address Fax Number:
253-804-2498
Provider Enumeration Date:
06/15/2009