Provider First Line Business Practice Location Address:
2817 GRIFFIN AVENUE
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:
360-825-3521
Provider Business Practice Location Address Fax Number:
360-825-6265
Provider Enumeration Date:
08/12/2006