Provider First Line Business Practice Location Address:
1144 29TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98001-2465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-486-0500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2007