Provider First Line Business Practice Location Address:
2949 GRIFFIN AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ENUMCLAW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98022-2378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-825-1661
Provider Business Practice Location Address Fax Number:
360-825-4712
Provider Enumeration Date:
11/15/2005