Provider First Line Business Practice Location Address:
8100 27TH ST 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:
98466-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-564-7911
Provider Business Practice Location Address Fax Number:
253-564-3649
Provider Enumeration Date:
10/25/2006