Provider First Line Business Practice Location Address:
7820 27TH 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:
98466-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-564-2001
Provider Business Practice Location Address Fax Number:
253-564-2004
Provider Enumeration Date:
05/22/2007