Provider First Line Business Practice Location Address:
1408 LAKE TAPPS PARKWAY EAST
Provider Second Line Business Practice Location Address:
SUITE E106
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-939-7179
Provider Business Practice Location Address Fax Number:
253-939-7182
Provider Enumeration Date:
05/16/2007