Provider First Line Business Practice Location Address:
1268 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-5748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-735-1991
Provider Business Practice Location Address Fax Number:
253-735-8837
Provider Enumeration Date:
08/29/2006