Provider First Line Business Practice Location Address:
5113 PACIFIC HWY E
Provider Second Line Business Practice Location Address:
SUITE3
Provider Business Practice Location Address City Name:
FIFE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98424-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-922-0229
Provider Business Practice Location Address Fax Number:
253-926-4183
Provider Enumeration Date:
03/31/2007