Provider First Line Business Practice Location Address:
18606 NE 149TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUSH PRAIRIE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98606-7137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-903-2645
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2013