Provider First Line Business Practice Location Address:
1501 15TH ST NW
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98001-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-929-8732
Provider Business Practice Location Address Fax Number:
253-929-8738
Provider Enumeration Date:
05/04/2012