Provider First Line Business Practice Location Address:
17241 SE 272ND ST
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-4965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-631-1200
Provider Business Practice Location Address Fax Number:
253-631-7147
Provider Enumeration Date:
01/19/2007