Provider First Line Business Practice Location Address:
1219 S BOONE ST
Provider Second Line Business Practice Location Address:
SOUTH SHORE MALL
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98520-6738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-533-5066
Provider Business Practice Location Address Fax Number:
360-533-5066
Provider Enumeration Date:
01/09/2007