Provider First Line Business Practice Location Address:
22015 50TH AVENUE CT E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPANAWAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98387-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-777-2549
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2007