Provider First Line Business Practice Location Address:
1300 ALAMEDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FIRCREST
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:
253-564-0202
Provider Business Practice Location Address Fax Number:
253-460-1460
Provider Enumeration Date:
12/22/2006