Provider First Line Business Practice Location Address:
19500 10TH AVE NE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
POULSBOE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-6331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-598-7500
Provider Business Practice Location Address Fax Number:
253-598-7505
Provider Enumeration Date:
09/12/2007