Provider First Line Business Practice Location Address:
10116 116TH ST E
Provider Second Line Business Practice Location Address:
SUITE 204-B
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98373-3543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-237-4188
Provider Business Practice Location Address Fax Number:
253-604-4533
Provider Enumeration Date:
10/24/2006