Provider First Line Business Practice Location Address:
5322 ORCHARD ST W
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:
98467-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-476-3333
Provider Business Practice Location Address Fax Number:
253-476-3334
Provider Enumeration Date:
05/05/2008