Provider First Line Business Practice Location Address:
1837 COLE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ENUMCLAW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98022-3555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-221-7312
Provider Business Practice Location Address Fax Number:
253-862-6254
Provider Enumeration Date:
03/28/2007