Provider First Line Business Practice Location Address:
23606 NE 178TH 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:
98606-7756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-635-3302
Provider Business Practice Location Address Fax Number:
360-891-7706
Provider Enumeration Date:
02/27/2009