Provider First Line Business Practice Location Address:
19200 N KELSEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-794-5555
Provider Business Practice Location Address Fax Number:
360-805-4797
Provider Enumeration Date:
10/18/2005