Provider First Line Business Practice Location Address:
11910 NE 154TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUSH PRAIRIE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-750-9588
Provider Business Practice Location Address Fax Number:
509-459-3920
Provider Enumeration Date:
07/30/2006