Provider First Line Business Practice Location Address:
5422 74TH ST W
Provider Second Line Business Practice Location Address:
SUITE B & C
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-7900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-475-9120
Provider Business Practice Location Address Fax Number:
253-475-9284
Provider Enumeration Date:
06/21/2011