Provider First Line Business Practice Location Address:
19410 NE 116TH 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:
98606-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-866-1927
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2015