Provider First Line Business Practice Location Address:
1006 FRYAR AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-863-2995
Provider Business Practice Location Address Fax Number:
253-863-3821
Provider Enumeration Date:
06/04/2014