Provider First Line Business Practice Location Address:
2424 MILDRED ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-6044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-5511
Provider Business Practice Location Address Fax Number:
253-393-5771
Provider Enumeration Date:
08/10/2026