Provider First Line Business Practice Location Address:
1006 FRYAR AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-863-0444
Provider Business Practice Location Address Fax Number:
253-863-1936
Provider Enumeration Date:
07/07/2005