Provider First Line Business Practice Location Address:
2660 GRIFFIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENUMCLAW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98022-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-825-6596
Provider Business Practice Location Address Fax Number:
360-802-0797
Provider Enumeration Date:
10/06/2006