Provider First Line Business Practice Location Address:
7406 27TH ST W
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-4632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-460-7248
Provider Business Practice Location Address Fax Number:
253-565-4409
Provider Enumeration Date:
05/16/2007