Provider First Line Business Practice Location Address:
21401 PACIFIC HWY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98198-6074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-824-4784
Provider Business Practice Location Address Fax Number:
206-878-3208
Provider Enumeration Date:
10/27/2010