Provider First Line Business Practice Location Address:
7501 29TH ST W
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-627-2330
Provider Business Practice Location Address Fax Number:
253-272-3443
Provider Enumeration Date:
12/01/2006