Provider First Line Business Practice Location Address:
39507 302ND AVE SE
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:
98022-7798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-359-8100
Provider Business Practice Location Address Fax Number:
559-793-3542
Provider Enumeration Date:
03/14/2007