Provider First Line Business Practice Location Address:
22625 PACIFIC HWY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98198-5110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-878-5665
Provider Business Practice Location Address Fax Number:
206-870-1504
Provider Enumeration Date:
03/22/2007