Provider First Line Business Practice Location Address:
1519 3RD STREET SE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-848-1574
Provider Business Practice Location Address Fax Number:
253-841-8949
Provider Enumeration Date:
10/02/2006