Provider First Line Business Practice Location Address:
7612 27TH STREET WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-308-3564
Provider Business Practice Location Address Fax Number:
253-336-4341
Provider Enumeration Date:
05/30/2006