Provider First Line Business Practice Location Address:
5920 100TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 32
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-582-7220
Provider Business Practice Location Address Fax Number:
253-582-0586
Provider Enumeration Date:
07/08/2006