Provider First Line Business Practice Location Address:
17110 16TH DRIVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98259-0220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-652-4500
Provider Business Practice Location Address Fax Number:
360-654-2036
Provider Enumeration Date:
10/03/2006