Provider First Line Business Practice Location Address:
22921 NE STATE ROUTE
Provider Second Line Business Practice Location Address:
3
Provider Business Practice Location Address City Name:
BELFAIR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-275-2855
Provider Business Practice Location Address Fax Number:
360-275-9536
Provider Enumeration Date:
02/01/2007