Provider First Line Business Practice Location Address:
14957 NORTH KELSEY ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-863-8070
Provider Business Practice Location Address Fax Number:
360-863-1252
Provider Enumeration Date:
08/21/2006