Provider First Line Business Practice Location Address:
5102 20TH ST E
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
FIFE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98424-1996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-922-3200
Provider Business Practice Location Address Fax Number:
253-922-3481
Provider Enumeration Date:
08/09/2006