Provider First Line Business Practice Location Address:
5909 ORCHARD ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98467-3824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-475-6021
Provider Business Practice Location Address Fax Number:
253-474-1871
Provider Enumeration Date:
01/29/2007