Provider First Line Business Practice Location Address:
4017 A ST. S.E.
Provider Second Line Business Practice Location Address:
B101
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-939-8144
Provider Business Practice Location Address Fax Number:
253-939-2289
Provider Enumeration Date:
01/16/2009