Provider First Line Business Practice Location Address:
19919 STATE RTE 2
Provider Second Line Business Practice Location Address:
MONROE PLAZA
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-805-0321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006