Provider First Line Business Practice Location Address:
2355 GRIFFIN AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ENUMCLAW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98022-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-709-0371
Provider Business Practice Location Address Fax Number:
360-802-2345
Provider Enumeration Date:
11/02/2005