Provider First Line Business Practice Location Address:
853 WATSON ST N STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENUMCLAW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98022-9348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-825-8300
Provider Business Practice Location Address Fax Number:
360-825-9255
Provider Enumeration Date:
08/16/2006