Provider First Line Business Practice Location Address:
232 ROOSEVELT 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:
98022-8242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-825-2558
Provider Business Practice Location Address Fax Number:
360-825-5941
Provider Enumeration Date:
09/03/2010