Provider First Line Business Practice Location Address:
2621 70TH AVE W STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-5459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-7522
Provider Business Practice Location Address Fax Number:
253-759-3552
Provider Enumeration Date:
06/04/2008