Provider First Line Business Practice Location Address:
5712 48TH 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:
98467-3676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-940-3407
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2025