Provider First Line Business Practice Location Address:
1220 BASICH BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98520-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-533-1243
Provider Business Practice Location Address Fax Number:
360-533-8333
Provider Enumeration Date:
11/04/2008