Provider First Line Business Practice Location Address:
5618 LAKEWOOD TOWNE CENTER BLVD SW
Provider Second Line Business Practice Location Address:
T0349
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-3894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-414-1232
Provider Business Practice Location Address Fax Number:
253-414-1232
Provider Enumeration Date:
06/20/2011