Provider First Line Business Practice Location Address:
5713 PARKER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-891-3569
Provider Business Practice Location Address Fax Number:
253-891-9433
Provider Enumeration Date:
03/22/2007