Provider First Line Business Practice Location Address:
2920 145TH AVENUE CT E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-9686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-334-0254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2026