Provider First Line Business Practice Location Address:
5216 52ND ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98467-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-254-4045
Provider Business Practice Location Address Fax Number:
253-736-9373
Provider Enumeration Date:
07/22/2013