Provider First Line Business Practice Location Address:
7810 WEST 27TH ST
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:
98466-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-564-2722
Provider Business Practice Location Address Fax Number:
253-564-0321
Provider Enumeration Date:
03/13/2007