Provider First Line Business Practice Location Address:
16501 64TH ST E STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-447-8216
Provider Business Practice Location Address Fax Number:
253-447-8789
Provider Enumeration Date:
11/02/2009