Provider First Line Business Practice Location Address:
1838 PORTER ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-979-3160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2012