Provider First Line Business Practice Location Address:
5919 N LEVEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FIFE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98424-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-922-5269
Provider Business Practice Location Address Fax Number:
253-922-0910
Provider Enumeration Date:
01/09/2007