Provider First Line Business Practice Location Address:
502 16TH ST NE
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
125-393-9224
Provider Business Practice Location Address Fax Number:
125-385-9498
Provider Enumeration Date:
05/11/2011