Provider First Line Business Practice Location Address:
1006 B FRYAR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-863-2995
Provider Business Practice Location Address Fax Number:
253-863-3821
Provider Enumeration Date:
08/24/2006