Provider First Line Business Practice Location Address:
144 169TH ST S
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SPANAWAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98387-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-536-2824
Provider Business Practice Location Address Fax Number:
253-536-3070
Provider Enumeration Date:
04/13/2011