Provider First Line Business Practice Location Address:
6001 100TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-582-5050
Provider Business Practice Location Address Fax Number:
253-582-5399
Provider Enumeration Date:
12/15/2006